| Neal J Gordon Edd Sc | |
|
4105 Rutgers Ln Northbrook IL 60062-2911 | |
| (708) 383-4671 | |
| Not Available |
| Full Name | Neal J Gordon Edd Sc |
|---|---|
| Speciality | Psychologist |
| Location | 4105 Rutgers Ln, Northbrook, Illinois |
| Authorized Official Name and Position | Neal Gordon (PRESIDENT) |
| Authorized Official Contact | 8476681164 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neal J Gordon Edd Sc 4105 Rutgers Ln Northbrook IL 60062-2911 Ph: () - | Neal J Gordon Edd Sc 4105 Rutgers Ln Northbrook IL 60062-2911 Ph: (708) 383-4671 |
| NPI Number | 1861869646 |
|---|---|
| Provider Enumeration Date | 08/27/2015 |
| Last Update Date | 08/27/2015 |
| Medicare PECOS PAC ID | 9739495136 |
|---|---|
| Medicare Enrollment ID | O20150831002264 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861869646 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071.002067 (Illinois) | Primary |
| Provider Name | Neal J Gordon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235169335 PECOS PAC ID: 8224132824 Enrollment ID: I20070409000066 |
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