Active NPI
Muriel P Gordon, NP
- Pediatric Nurse Practitioner
- Amityville, NY
National Provider Identifier
1902816028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- F3806541
- Practice address
- 1080 Sunrise Hwy
Maxine Postal Tri Community Clinic
Amityville, NY 11701 - Phone
- (631) 854-1022
- Fax
- (631) 854-1031
- NPI assigned
- Aug 9, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | F3806541 | NY | Primary |
Addresses
Primary practice location
1080 Sunrise Hwy
Maxine Postal Tri Community Clinic
Amityville, NY 11701
Mailing address
1080 Sunrise Hwy
Maxine Postal Tri Community Clinic
Amityville, NY 11701
Phone (631) 854-1022
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01770290 | Medicaid | NY |
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
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F3806541 | NY | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902816028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1080 SUNRISE HWY",
"address_2": "MAXINE POSTAL TRI COMMUNITY CLINIC",
"city": "AMITYVILLE",
"state": "NY",
"postal_code": "11701",
"telephone_number": "631-854-1022",
"fax_number": "631-854-1031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1080 SUNRISE HWY",
"address_2": "MAXINE POSTAL TRI COMMUNITY CLINIC",
"city": "AMITYVILLE",
"state": "NY",
"postal_code": "11701",
"telephone_number": "631-854-1022",
"fax_number": "631-854-1031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "MURIEL",
"middle_name": "P",
"name_prefix": "Ms.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "NY",
"license": "F3806541",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01770290",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Amityville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.