Provider Demographics
NPI:1770555856
Name:GORDON, KAREN ANN (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:KORETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:347 MOUNT PLEASANT AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2744
Mailing Address - Country:US
Mailing Address - Phone:973-571-2121
Mailing Address - Fax:973-571-2126
Practice Address - Street 1:60 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044
Practice Address - Country:US
Practice Address - Phone:973-571-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06841800207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G25871Medicare UPIN
NJ031279NR4Medicare ID - Type UnspecifiedGROUP NUMBER