Gordon, Mark Howard
Gordon, Mark Howard is an sole proprietor health care provider with primary practice located at 15 Fletcher Ave , Valley Stream NY 11580-4000. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Gordon, Mark Howard can be contacted via phone (516) 561-1577.Contact Information
Primary practice address
15 Fletcher Ave
Valley Stream NY 11580-4000
Phone: (516) 561-1577
Fax: (516) 561-1577
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 036092 | New York |
Profile Details
| NPI number | 1396734331 |
|---|---|
| LBN Legal business name | Gordon, Mark Howard |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 20th, 2005 |
| 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 | 1396734331 | NPPES |
| New York | MEDICAID | 00717506 |
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