Gordon, Jonathan Mark

Gordon, Jonathan Mark is an individual health care provider with primary practice located at 21 South St , Ridgefield CT 06877-4102. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pulmonary Disease. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Gordon, Jonathan Mark can be contacted via phone (203) 438-6541.

Contact Information

Primary practice address
21 South St Ridgefield CT 06877-4102
Phone: (203) 438-6541
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 017998 Connecticut
Allopathic & Osteopathic Physicians / Pulmonary Disease 207RP1001X 017998 Connecticut

Profile Details

NPI number 1124057005
LBN Legal business name Gordon, Jonathan Mark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 2nd, 2006
Last updated Aug 19th, 2016 - about 9 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124057005 NPPES
Connecticut MEDICAID 1179985

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