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
Fax: (516) 465-1890
Website:

Health care specialties

SpecialtyCodeLicense #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 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124098959 NPPES
New York MEDICAID 01155568

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