Active NPI
Randall Gordon Jr.
- Driver
- Mount Vernon, NY
National Provider Identifier
1467141531
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- Practice address
- 30 Park Ave Apt 1L
Mount Vernon, NY 10550-2151 - Phone
- (347) 341-9334
- NPI assigned
- May 4, 2023
- Last updated
- May 4, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Personal Care Attendant | 3747P1801X | NY | ||
| Driver | 172A00000X | NY | Primary |
Addresses
Primary practice location
30 Park Ave Apt 1L
Mount Vernon, NY 10550-2151
Mailing address
30 Park Ave Apt 1L
Mount Vernon, NY 10550-2151
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683158400000",
"number": "1467141531",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 PARK AVE APT 1L",
"city": "MOUNT VERNON",
"state": "NY",
"postal_code": "105502151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 PARK AVE APT 1L",
"city": "MOUNT VERNON",
"state": "NY",
"postal_code": "105502151",
"telephone_number": "347-341-9334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "RANDALL",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-04",
"last_updated": "2023-05-04",
"certification_date": "2023-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "3747P1801X",
"taxonomy_group": "",
"desc": "Technician, Personal Care Attendant",
"state": "NY",
"license": null,
"primary": false
},
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "NY",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.