Provider Demographics
NPI:1326033143
Name:GOULD, JEFFREY D (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:GOULD
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 1:6 RIVERVIEW PLZ
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1863
Mailing Address - Country:US
Mailing Address - Phone:732-747-1429
Mailing Address - Fax:732-747-4778
Practice Address - Street 1:6 RIVERVIEW PLZ
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1863
Practice Address - Country:US
Practice Address - Phone:732-747-1429
Practice Address - Fax:732-747-4778
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA415292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22684OtherAMERIGROUP
NJ4099590OtherGHI
NJ0004093776OtherAETNA POS
NJ808835OtherUSA MANAGED CARE
NJ3628704OtherAETNA HMO
NJ651U11OtherWELLCHOICE
NJP00053553OtherRR MEDICARE
NJ0091567000OtherAMERIHEALTH
NJ1044575OtherHORIZON/MERCY
NJ0733747OtherAETNA HMO
NJ0988456-007OtherCIGNA
NJ1227452OtherUNITED HEALTHCARE
NJ1861603Medicaid
NJ0988456-007OtherCIGNA
NJG0194288Medicare ID - Type UnspecifiedMEIDCARE