Provider Demographics
NPI:1538399670
Name:GORDON, ANTHONY (DAC,LAC, LMT)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:DAC,LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 LANDING AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2711
Mailing Address - Country:US
Mailing Address - Phone:631-708-3500
Mailing Address - Fax:631-708-3500
Practice Address - Street 1:38 LANDING AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2711
Practice Address - Country:US
Practice Address - Phone:631-708-3500
Practice Address - Fax:631-708-3500
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004558171100000X
NY019129225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist