Provider Demographics
NPI:1083641203
Name:GOLD, JULIE (CNM, PMHNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:CNM, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4201
Mailing Address - Country:US
Mailing Address - Phone:718-926-5522
Mailing Address - Fax:718-797-4044
Practice Address - Street 1:524 8TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4201
Practice Address - Country:US
Practice Address - Phone:718-926-5522
Practice Address - Fax:718-797-4044
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000657176B00000X
NY402968363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1779771Medicaid
S49974Medicare UPIN