Individual ProviderI Bruce GordonPediatricsAllopathic & Osteopathic PhysiciansPractice Address120 W 57th St, 904, New York, NY 10019-3320(212) 632-4520PECOS EnrollmentBased on the most recent information from CMS, provider I Bruce Gordon does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1174721526Provider TypeIndividualFull NameGordon, I BruceTitleDr.CredentialMDGenderMaleSole ProprietorYesEnumeration Date7/6/2007Last Updated7/8/2007Contact InformationPractice LocationPractice Address120 W 57th St, 904, New York, NY 10019-3320Phone(212) 632-4520Fax(212) 307-7896Mailing LocationMailing Address120 W 57th St, 904, New York, NY 10019-3320Phone(212) 632-4520Fax(212) 307-7896Provider TaxonomiesCodeDescriptionLicenseCode208000000XPrimaryDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicense094231New York