Jeanine Gurdon

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

018212 Issued in NY

Practice address

15 Dick CT
Northport, NY 11768-1900

Phone

(631) 379-0271

NPI assigned

Oct 29, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Catskill Dermatology, PC

  • Dermatology Physician
  • Monticello, NY
  • NPI 1235279233
  Medicare reassignment NPD

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

{
    "created_epoch": "1414540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414540800000",
    "number": "1922403245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 DICK CT",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117681900",
            "telephone_number": "631-379-0271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 DICK CT",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117681900",
            "telephone_number": "631-379-0271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GURDON",
        "first_name": "JEANINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-29",
        "last_updated": "2014-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suzanne L Gruber, RPH
• Maribeth Clark Gruhn
• Stephanie Guadagno
• Holly K. Guercio, CTRS
• Susan Gunduz, MD
• Anne Letitia Gutting, OTR MACHT
• Marwan Habeeb, M.D.
• Kerry Haddock, PSY.D.
• Victoria Lee Hadix
• Elizabeth A Haeni, DPM

• Physician Assistant in Northport, NY
• Providers in Northport, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2014; 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.

Verify at the official NPI Registry.