Miriam Gordon Pediatric NP PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

381940 Issued in NY

Legal business name

MIRIAM GORDON PEDIATRIC NP PC

Practice address

6010 Bay Pkwy FL 9
Brooklyn, NY 11204-6079

Phone

(718) 238-2100

Fax

(718) 815-8122

NPI assigned

Apr 16, 2015

Organization subpart

No

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

Authorized official

Name

Miriam Gordon, NP

Title

Coo

Phone

(718) 815-1000

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Miriam Gordon Pediatric NP PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Miriam Gordon Pediatric NP PC

  • Pediatric Nurse Practitioner
  • Staten Island, NY
  • NPI 1750845137
  NPD tax ID

Locations

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

{
    "created_epoch": "1429142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429142400000",
    "number": "1306233408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 MANOR RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103142408",
            "telephone_number": "718-815-1000",
            "fax_number": "718-815-8122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6010 BAY PKWY FL 9",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112046079",
            "telephone_number": "718-238-2100",
            "fax_number": "718-815-8122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRIAM GORDON PEDIATRIC NP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-16",
        "last_updated": "2015-04-16",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "MIRIAM",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "718-815-1000",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "381940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02460364",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Mireau, LMSW
• Ilya Mirensky
• Jacob Mirer, PTA
• Anna Miretsky, LMSW
• Frank Mirharoon, D.D.S
• Miriam Levy Licensed Behavior Analyst PC
• Mirimus, Inc.
• Ananya Mirji
• Boris A. Mirkin
• Nina Mirkin, LMSW

• Pediatric Nurse Practitioner in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Pediatric Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2015; 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.