Provider Demographics
NPI:1861698672
Name:BARRY GORDON, M.D.,P.C.
Entity type:Organization
Organization Name:BARRY GORDON, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:E.
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-252-2627
Mailing Address - Street 1:5601 FLATLANDS AVE # 5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2501
Mailing Address - Country:US
Mailing Address - Phone:718-252-2627
Mailing Address - Fax:718-252-4373
Practice Address - Street 1:5601 FLATLANDS AVE # 5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2501
Practice Address - Country:US
Practice Address - Phone:718-252-2627
Practice Address - Fax:718-252-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097198207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY436671Medicare UPIN
NYG66917Medicare UPIN