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DR. DUSTIN JOEL GORDON PH.D.

Clinical Neuropsychologist

Ridgwood, New Jersey

Provider NPI: 1124126404

Provider Information:
DR. DUSTIN JOEL GORDON PH.D.
Gender: M
Sole Proprietor


Practice Location:
61 N. MAPLE AVE. STE 103 RIDGWOOD, NJ 07450 US
Tel: 201-670-9773  Fax: 973-427-1463

Business Mailing Address:
61 N. MAPLE AVE. STE 103 RIDGWOOD, NJ 07450 US
Tel: 201-670-9773  Fax: 973-427-1463

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
NJ3610

Other Provider Identifiers:

IssuerNumberStateType
7469028NJ05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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