Provider Demographics
NPI:1528194594
Name:GOLD, JOEL R (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:R
Last Name:GOLD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOEL
Other - Middle Name:
Other - Last Name:GAVRIELE-GOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:205 W 89TH ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1828
Mailing Address - Country:US
Mailing Address - Phone:212-362-2167
Mailing Address - Fax:212-595-6053
Practice Address - Street 1:205 W 89TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1828
Practice Address - Country:US
Practice Address - Phone:212-362-2167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7570-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV62321Medicare ID - Type Unspecified
NYR52984Medicare UPIN