Provider Demographics
NPI:1487875936
Name:GORDIN, ALBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:GORDIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 FULTON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2003
Mailing Address - Country:US
Mailing Address - Phone:718-789-0909
Mailing Address - Fax:718-789-6969
Practice Address - Street 1:1276 FULTON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2003
Practice Address - Country:US
Practice Address - Phone:718-789-0909
Practice Address - Fax:718-789-6969
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0430671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01258680Medicaid