Individual provider Active NPI

Lynette Patricia Julien- Gordon, RPH

  • Pharmacist
  • Brooklyn, NY
National Provider Identifier
1619150240
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
042635 Issued in NY
Practice address
226 Schenectady Ave
Brooklyn, NY 11213-3702
Phone
(718) 484-7735
NPI assigned
Dec 5, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 042635 NY Primary

Addresses

Primary practice location

226 Schenectady Ave
Brooklyn, NY 11213-3702

Mailing address

226 Schenectady Ave
Brooklyn, NY 11213-3702
Phone (718) 484-7735

Other identifiers 1

IdentifierTypeStateIssuer
01719942MedicaidNY

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
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
042635NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Rockaway Ave Pharmacy Inc Pharmacist CurrentSince Jun 22, 2021 Accepting new patients

Locations

226 Schenectady Ave
Brooklyn, NY 11213
Phone (718) 484-7735

Organizations & group practices 1

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": "1196812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1619150240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 SCHENECTADY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112133702",
            "telephone_number": "718-484-7735",
            "fax_number": "718-484-7736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 SCHENECTADY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112133702",
            "telephone_number": "718-484-7735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JULIEN- GORDON",
        "first_name": "LYNETTE",
        "middle_name": "PATRICIA",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-05",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "042635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01719942",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; 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.