Staten Island Medical Professional PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

097198 Issued in NY

Legal business name

STATEN ISLAND MEDICAL PROFESSIONAL PC

Practice address

5405 Hylan Blvd
Staten Island, NY 10312-5241

Phone

(718) 356-0207

NPI assigned

Jan 18, 2011

Last updated

Jan 18, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Edwin Barry Gordon, M.D

Title

Owner

Phone

(718) 356-0207

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1295308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295308800000",
    "number": "1659676963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5405 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103125241",
            "telephone_number": "718-356-0207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5405 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103125241",
            "telephone_number": "718-356-0207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEN ISLAND MEDICAL PROFESSIONAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-18",
        "last_updated": "2011-01-18",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_middle_name": "BARRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-356-0207",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "097198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Staten Island Medical Group, PLLC
• Staten Island Medical Intensivist PC
• Staten Island Medical of New York LLC
• Staten Island Medical of New York, LLC
• Staten Island Medical Practice, P.C.
• Staten Island Medical Rehabilitation, P.C.
• Staten Island Medicine PC
• Staten Island Mental Health Counseling PLLC
• Staten Island Mental Health Society
• Staten Island Mental Health Society

• Internal Medicine Physician in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2011; 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.