Provider Demographics
NPI:1043505647
Name:GOLD, MARTHA HOLLY
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:HOLLY
Last Name:GOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 29TH ST
Mailing Address - Street 2:3K
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2855
Mailing Address - Country:US
Mailing Address - Phone:917-359-9319
Mailing Address - Fax:
Practice Address - Street 1:2331 29TH ST
Practice Address - Street 2:3K
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2855
Practice Address - Country:US
Practice Address - Phone:917-359-9319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist