Active NPI
Lara Gordon, M.D.
- Pediatric Adolescent Medicine Physician
- New York, NY
National Provider Identifier
1417015116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Adolescent Medicine Physician
- License
- 219564-1
- Practice address
- 215 E 79TH St
New York, NY 10021-0847 - Phone
- (212) 737-7800
- Fax
- (212) 737-0251
- NPI assigned
- Dec 5, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | 219564-1 | NY | Primary |
Addresses
Primary practice location
215 E 79TH St
New York, NY 10021-0847
Mailing address
215 E 79TH St
New York, NY 10021-0847
Phone (212) 737-7800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 219564-1 | NY | MD | Pediatric Adolescent Medicine Physician |
Interoperability endpoints
- lag9002@direct.nyp.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417015116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 E 79TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100210847",
"telephone_number": "212-737-7800",
"fax_number": "212-737-0251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 E 79TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100210847",
"telephone_number": "212-737-7800",
"fax_number": "212-737-0251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "LARA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "NY",
"license": "219564-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.