Provider Demographics
NPI:1073347100
Name:GORDON, ADAM GABRIEL (OTR/L)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:GABRIEL
Last Name:GORDON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 QUEEN ANNE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3521
Mailing Address - Country:US
Mailing Address - Phone:201-837-9993
Mailing Address - Fax:
Practice Address - Street 1:1415 QUEEN ANNE RD STE 100
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3521
Practice Address - Country:US
Practice Address - Phone:201-837-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01163100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist