Provider Demographics
NPI:1083641765
Name:GOLD, JEFFREY L (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:GOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 PARISH DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4671
Mailing Address - Country:US
Mailing Address - Phone:973-686-2777
Mailing Address - Fax:973-686-2780
Practice Address - Street 1:468 PARISH DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4671
Practice Address - Country:US
Practice Address - Phone:973-305-8300
Practice Address - Fax:973-305-8157
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA36557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4798201Medicaid
D19725Medicare UPIN
NJ4798201Medicaid