| Doctor Name: | ROMAINE GORDON |
| NPI Number: | 1053659292 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CASAC |
| License Number: | 17613 |
| Business Practice Address: | 4271 Hempstead Tpke Bethpage, NY - 117145708 |
| Business Phone Number: | 5165206600 |
| Business Fax Number: | 5165206750 |
| Mailing Address: | 4271 Hempstead Tpke, BETHPAGE |
| State: | NY |
| Postal Code: | 117145708 |
| Phone Number: | 5165206600 |
| Fax Number: | 5165206750 |
| NPI Enumeration Date: | 01/23/2013 |
| NPI Last Update Date: | 01/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 17613 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |