Active NPI
Daniel Joshua Gordon, OD
- Optometrist
- Tenafly, NJ
National Provider Identifier
1871623009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4673
- Practice address
- 120 County Rd
Tenafly, NJ 07670-1854 - Phone
- (201) 567-0157
- NPI assigned
- Mar 6, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4673 | NJ | Primary |
Addresses
Primary practice location
120 County Rd
Tenafly, NJ 07670-1854
Mailing address
19 Sunset Ter
Tenafly, NJ 07670-1456
Phone (201) 567-6588
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050728000065 | NJ | Practitioner - Optometry | 4486682846 | Practice locations: Tenafly, NJ |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4673 | NJ | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339718400000",
"number": "1871623009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 SUNSET TER",
"city": "TENAFLY",
"state": "NJ",
"postal_code": "076701456",
"telephone_number": "201-567-6588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 COUNTY RD",
"city": "TENAFLY",
"state": "NJ",
"postal_code": "076701854",
"telephone_number": "201-567-0157"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "DANIEL",
"middle_name": "JOSHUA",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-06",
"last_updated": "2012-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NJ",
"license": "4673",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tenafly, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.