Individual provider Active NPI

Debra Lynn Gordon, PT

  • Physical Therapist
  • Monroe, NY
National Provider Identifier
1548033566
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
007033 Issued in NY
Practice address
745 State Route 17M Ste 104
Monroe, NY 10950-2663
Phone
(845) 364-7312
Fax
(845) 440-1311
NPI assigned
Nov 1, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 007033 NY Primary

Addresses

Primary practice location

745 State Route 17M Ste 104
Monroe, NY 10950-2663

Mailing address

16 Maybrook Rd Ste L
Campbell Hall, NY 10916-2741
Phone (845) 636-4344

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231207000653 NY Practitioner - Physical Therapist in Private Practice 7214013051 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
007033NYMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Feb 1, 2026 Accepting new patients
Access PT, OT, New York, PLLC Physical Therapist CurrentSince Oct 30, 2023 Accepting new patients
Montefiore Medical Center CurrentSince Feb 1, 2026 Accepting new patients
Montefiore Medical Center Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

16 Maybrook Rd
Ste L
Campbell Hall, NY 10916

111 Maiden Ln
Kingston, NY 12401
Phone (845) 331-8590

785 State Route 17M
Monroe, NY 10950
Phone (845) 356-2900

745 State Route 17M
Ste 104
Monroe, NY 10950
Phone (845) 561-8060

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1698796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1548033566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 MAYBROOK RD STE L",
            "city": "CAMPBELL HALL",
            "state": "NY",
            "postal_code": "109162741",
            "telephone_number": "845-636-4344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 STATE ROUTE 17M STE 104",
            "city": "MONROE",
            "state": "NY",
            "postal_code": "109502663",
            "telephone_number": "845-364-7312",
            "fax_number": "845-440-1311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "DEBRA",
        "middle_name": "LYNN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-01",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "007033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.