Gordon, Mark Forrest
Gordon, Mark Forrest is an individual health care provider with primary practice located at 865 Northern Blvd , Great Neck NY 11021-5310. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Gordon, Mark Forrest can be contacted via phone (516) 570-4477.Contact Information
Primary practice address
865 Northern Blvd
Great Neck NY 11021-5310
Phone: (516) 570-4477
Fax: (516) 465-1890
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 167467 | New York |
Profile Details
| NPI number | 1124098959 |
|---|---|
| LBN Legal business name | Gordon, Mark Forrest |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 24th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124098959 | NPPES |
| New York | MEDICAID | 01155568 |
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