Dustin Joel Gordon, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

3610 Issued in NJ

Practice address

61 N. Maple Ave.
Ste 103
Ridgwood, NJ 07450

Phone

(201) 670-9773

Fax

(973) 427-1463

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1996

Medicare assignment

May accept Medicare assignment

Group practices

VDB Enterprises LLCGroup PAC ID 1658421649, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• VDB Enterprises, LLC

  • Rehabilitation Clinic/Center
  • Fair Lawn, NJ
  • NPI 1972754679
  Medicare reassignment Care Compare group NPD
• Marvin Leibowitz PH.D. LLC

  • Clinical Psychologist
  • Ridgewood, NJ
  • NPI 1578809448
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124126404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 N. MAPLE AVE.",
            "address_2": "STE 103",
            "city": "RIDGWOOD",
            "state": "NJ",
            "postal_code": "07450",
            "telephone_number": "201-670-9773",
            "fax_number": "973-427-1463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 N. MAPLE AVE.",
            "address_2": "STE 103",
            "city": "RIDGWOOD",
            "state": "NJ",
            "postal_code": "07450",
            "telephone_number": "201-670-9773",
            "fax_number": "973-427-1463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "DUSTIN",
        "middle_name": "JOEL",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NJ",
            "license": "3610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7469028",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Anne Cornell Louis, LPC

• Clinical Neuropsychologist in Ridgwood, NJ
• Providers in Ridgwood, NJ by specialty
• Clinical Neuropsychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.