Provider Demographics
NPI:1427097500
Name:GORDON, LEONARD F (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:F
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BRIDGETON PIKE STE D
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2616
Mailing Address - Country:US
Mailing Address - Phone:856-339-6054
Mailing Address - Fax:856-935-6714
Practice Address - Street 1:310 SALEM WOODSTOWN RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-2064
Practice Address - Country:US
Practice Address - Phone:856-339-6054
Practice Address - Fax:856-935-6714
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021520E2085B0100X, 2085R0202X
NJ25MA050004002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0907065Medicaid
PA0009070650021Medicaid
NJ051224Medicare PIN
PA0907065Medicaid
PAC28618Medicare UPIN
PA059805Medicare PIN