Ivylyn Gordon

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

183896-1 Issued in NY

Practice address

3480 Seymour Ave
Apt # 1 B
Bronx, NY 10469-2144

Phone

(718) 882-3100

NPI assigned

Mar 29, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1003935941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 690012",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104690760",
            "telephone_number": "718-882-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3480 SEYMOUR AVE",
            "address_2": "APT # 1 B",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104692144",
            "telephone_number": "718-882-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "IVYLYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "183896-1",
            "primary": true
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "CT",
            "license": "030714",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01686497",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donald Gordon
• Dorett Beverly Gordon
• Garet M Gordon, MD
• Geneve Shaun Gordon, LPN
• Ivan Gordon, R.PH.
• Jahira Gordon
• Jaimee M Gordon
• Jason R Gordon, DDS
• Kathleen Gordon, MS-ED
• Kenneth Gordon Jr.

• Licensed Practical Nurse in Bronx, NY
• Providers in Bronx, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.