Provider Demographics
NPI:1548287568
Name:RICHARD D GORDON, M.D., P.A.
Entity type:Organization
Organization Name:RICHARD D GORDON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:S
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-587-9898
Mailing Address - Street 1:2121 KLOCKNER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3417
Mailing Address - Country:US
Mailing Address - Phone:609-587-9898
Mailing Address - Fax:609-584-1774
Practice Address - Street 1:2121 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3417
Practice Address - Country:US
Practice Address - Phone:609-587-9898
Practice Address - Fax:609-584-1774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3070000Medicaid
PA07650482Medicaid
NJ870201Medicare ID - Type Unspecified
NJ3070000Medicaid
NJ870201Medicare PIN