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DR. DUSTIN JOEL GORDON PH.D.
NPI 1124126404
Clinical Neuropsychologist in Ridgwood, NJ

Active since September 20, 2006PECOS Enrolled
61 N. MAPLE AVE., STE 103, RIDGWOOD, NJ 07450(201) 670-9773(973) 427-1463 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Dustin Joel Gordon Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DUSTIN JOEL GORDON PH.D. (NPI 1124126404) is an individual clinical neuropsychologist in Ridgwood, New Jersey, licensed in New Jersey (3610) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS and is a graduate of Other (1996).

NPPES Registry Identity

NPI1124126404
Entity TypeIndividualMale
Primary Taxonomy103G00000X
Provider Legal NameDR. DUSTIN JOEL GORDONCredential: PH.D.
Location Address61 N. MAPLE AVE., STE 103Ridgwood, NJ 07450
Mailing Address61 N. Maple Ave., Ste 103Ridgwood, NJ 07450 · (201) 670-9773 · Fax (973) 427-1463
Phone(201) 670-9773
Fax(973) 427-1463
Sole ProprietorYes
Medical School CMSOtherGraduated 1996
Enumeration DateSeptember 20, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1124126404 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinical NeuropsychologistBehavioral Health & Social Service Providers
Taxonomy Code103G00000X
License✔ Licensed in NJ · 3610
Definition
A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.
61 N. MAPLE AVE., Ridgwood, NJ 07450
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Other Identifiers 2

Medicare ID-Type UnspecifiedGO008948NJ
Medicaid7469028NJ

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Dustin Joel Gordon Ph.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID42252850
PECOS Enrollment IDI20050523000607
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dustin Gordon's NPI number?

The NPI number for Dustin Gordon is 1124126404. It was assigned to this individual provider in the NPPES registry on September 20, 2006.

Where is Dustin Gordon located?

Dustin Gordon practices at 61 N. Maple Ave. Ste 103, Ridgwood, NJ 07450. The listed phone number is (201) 670-9773.

What is Dustin Gordon's specialty?

The primary specialty registered for this NPI is Clinical Neuropsychologist with taxonomy code 103G00000X.

Is Dustin Gordon enrolled in Medicare?

Yes. Dustin Gordon is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Dustin Gordon was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.