Gordon, Peta-Gaye Tisha

Gordon, Peta-Gaye Tisha is an sole proprietor health care provider with primary practice located at 127 Maple Ln , Medford NY 11763-1027. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Licensed Practical Nurse, Nursing Service Providers / Registered Nurse. Nursing Service Providers / Registered Nurse is her primary health care specialty. Gordon, Peta-Gaye Tisha can be contacted via phone (631) 576-5833.

Contact Information

Primary practice address
127 Maple Ln Medford NY 11763-1027
Phone: (631) 576-5833
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Licensed Practical Nurse 164W00000X 279643-1 New York
Nursing Service Providers / Registered Nurse 163W00000X 629991 New York

Profile Details

NPI number 1053645341
LBN Legal business name Gordon, Peta-Gaye Tisha
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 20th, 2009
Last updated Apr 15th, 2024 - about 7 months 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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