Provider Demographics
NPI:1437289238
Name:JEFFREY L GOLD,MD,PA
Entity Type:Organization
Organization Name:JEFFREY L GOLD,MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-471-8850
Mailing Address - Street 1:1135 BROAD ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3346
Mailing Address - Country:US
Mailing Address - Phone:973-471-8850
Mailing Address - Fax:973-471-5232
Practice Address - Street 1:1135 BROAD ST
Practice Address - Street 2:SUITE 205
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3346
Practice Address - Country:US
Practice Address - Phone:973-471-8850
Practice Address - Fax:973-471-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1083641765OtherNPI
NJ4798201Medicaid
NJ467570Medicare ID - Type Unspecified
NJ4798201Medicaid