Michelle Gordon

Primary specialty

SpecialistTaxonomy code 174400000X

License

437978 Issued in NY

Practice address

673 Columbia Tpke
East Greenbush, NY 12061-2130

Phone

(518) 233-0544

NPI assigned

Apr 13, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Michelle Benjamin Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Capital District Beginnings

  • Early Intervention Provider Agency
  • East Greenbush, NY
  • NPI 1790222313
  NPD (past)

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

{
    "created_epoch": "1460505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460505600000",
    "number": "1275997413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 IRONWOOD DR",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121103644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "673 COLUMBIA TPKE",
            "city": "EAST GREENBUSH",
            "state": "NY",
            "postal_code": "120612130",
            "telephone_number": "518-233-0544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-13",
        "last_updated": "2016-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "437978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "BENJAMIN",
            "prefix": "MS.",
            "credential": "M.S E.D",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Latesha Gibson
• Ashley Gillies
• Samantha Godfrey, RN
• Christine Marie Goodemote, DDS, MS
• Brittany Gordon
• Jorianna Graham
• Green Manor Dialysis Center LLC
• Saleema Grier, LPN
• Michelle Griffin
• Winter Michelle Guffey, D.C.

• Specialist in East Greenbush, NY
• Providers in East Greenbush, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2016; 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.