Gordon C Davis, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

171745 Issued in NY

Practice address

9601 Jamaica Ave Lowr Level
Woodhaven, NY 11421-2295

Phone

(718) 641-4900

Fax

(718) 641-4905

NPI assigned

Feb 22, 2007

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

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

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.

• Good Will Medical, P.C.

  • Family Medicine Physician
  • Far Rockaway, NY
  • NPI 1245340207
  NPD (past)
• Good Will Medical, P.C.

  • Internal Medicine Physician
  • Melville, NY
  • NPI 1841442357
  NPD (past)

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713484800000",
    "number": "1124153101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10149 WOODHAVEN BLVD",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "114162300",
            "telephone_number": "718-641-4900",
            "fax_number": "718-641-4905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9601 JAMAICA AVE LOWR LEVEL",
            "city": "WOODHAVEN",
            "state": "NY",
            "postal_code": "114212295",
            "telephone_number": "718-641-4900",
            "fax_number": "718-641-4905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "GORDON",
        "middle_name": "C",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-22",
        "last_updated": "2024-04-19",
        "certification_date": "2024-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "171745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Marie Coursey, MA, CCC-SLP, TSHH
• Alice Crespi
• Flavio Crisari, M.D.
• Marie Antoinette Cyrius
• Georgiy Davidov, PHARM. D
• Karen Dela Santa-Pura, MS OTR/L
• Karina A Delgado
• Louis Thomas Demartino
• Damian Demolina
• Dental Universe

• Family Medicine Physician in Woodhaven, NY
• Providers in Woodhaven, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.