Provider Demographics
NPI:1588713473
Name:JILL GORDON, INC.
Entity type:Organization
Organization Name:JILL GORDON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:732-303-9660
Mailing Address - Street 1:4257 US HIGHWAY 9
Mailing Address - Street 2:BLDG. 6
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8310
Mailing Address - Country:US
Mailing Address - Phone:732-303-9660
Mailing Address - Fax:
Practice Address - Street 1:4257 US HIGHWAY 9
Practice Address - Street 2:BLDG. 6
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8310
Practice Address - Country:US
Practice Address - Phone:732-303-9660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ200033Medicare ID - Type Unspecified