Individual ProviderPeta-Gaye GordonRegistered NurseNursing Service ProvidersPractice Address3215 Seymour Ave, Bronx, NY 10469-2917(347) 740-5621PECOS EnrollmentBased on the most recent information from CMS, provider Peta-Gaye 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 7 days ago.Profile DetailsProvider ID1740664374Provider TypeIndividualFull NameGordon, Peta-GayeGenderFemaleSole ProprietorYesEnumeration Date7/14/2015Last Updated7/15/2015Contact InformationPractice LocationPractice Address3215 Seymour Ave, Bronx, NY 10469-2917Phone(347) 740-5621FaxUnlisted FaxMailing LocationMailing Address3215 Seymour Ave, Bronx, NY 10469-2917Phone(347) 740-5621FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode163W00000XPrimaryDescriptionRegistered NurseNursing Service ProvidersLicense700285New YorkCode164W00000XDescriptionLicensed Practical NurseNursing Service ProvidersLicense2804431New York