Provider Demographics
NPI:1538273065
Name:GORDON, ALAN STUART (EDD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:STUART
Last Name:GORDON
Suffix:
Gender:M
Credentials:EDD
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Mailing Address - Street 1:196 PRINCETON HIGHTSTOWN RD
Mailing Address - Street 2:BUILDING 1 SECOND FLOOR
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-1672
Mailing Address - Country:US
Mailing Address - Phone:609-799-3866
Mailing Address - Fax:609-799-7930
Practice Address - Street 1:196 PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:BUILDING 1 SECOND FLOOR
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-1672
Practice Address - Country:US
Practice Address - Phone:609-799-3866
Practice Address - Fax:609-799-7930
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJSI01000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ069977Medicare ID - Type UnspecifiedPSYCHOLOGIST