Gordon, Dustin Joel

Gordon, Dustin Joel is an sole proprietor health care provider with primary practice located at 61 N. Maple Ave. Ste 103, Ridgwood NJ 07450. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Neuropsychologist, which is considered as his primary health care specialty. Gordon, Dustin Joel can be contacted via phone (201) 670-9773.

Contact Information

Primary practice address
61 N. Maple Ave. Ste 103 Ridgwood NJ 07450
Phone: (201) 670-9773
Fax: (973) 427-1463
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X 3610 New Jersey

Profile Details

NPI number 1124126404
LBN Legal business name Gordon, Dustin Joel
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 20th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1124126404 NPPES
New Jersey MEDICAID 7469028

Popular Providers