1326281890 NPI number — MAIMONIDES MEDICAL CENTER INTERVENTIONAL RADIOLOGY FPP

Table of content: DR. ROBERT STEVENSON GORDON III DO (NPI 1457047342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326281890 NPI number — MAIMONIDES MEDICAL CENTER INTERVENTIONAL RADIOLOGY FPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAIMONIDES MEDICAL CENTER INTERVENTIONAL RADIOLOGY FPP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326281890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
GPO BOX 27613
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10087-7613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-283-8773
Provider Business Mailing Address Fax Number:
718-283-8796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4802 10TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11219-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-283-8773
Provider Business Practice Location Address Fax Number:
718-283-8796
Provider Enumeration Date:
04/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CAMMER
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
718-283-8773

Provider Taxonomy Codes

  • Taxonomy code: 2085N0700X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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