Provider Demographics
NPI:1033281340
Name:GOLD, JANE MENCHER (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:MENCHER
Last Name:GOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 BIRCH GROVE DR
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-2521
Mailing Address - Country:US
Mailing Address - Phone:914-273-7858
Mailing Address - Fax:914-810-1518
Practice Address - Street 1:401 COLUMBUS AVE
Practice Address - Street 2:SUITE LL1
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1325
Practice Address - Country:US
Practice Address - Phone:914-769-0268
Practice Address - Fax:914-769-6303
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05186992Medicaid
NY05186992Medicaid
NY749491Medicare ID - Type UnspecifiedCURRENTLY INACTIVE