Provider Demographics
NPI:1578668307
Name:GINGOLD, JODILYN (MD,FCCP)
Entity Type:Individual
Prefix:DR
First Name:JODILYN
Middle Name:
Last Name:GINGOLD
Suffix:
Gender:F
Credentials:MD,FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6254 97TH PL
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1346
Mailing Address - Country:US
Mailing Address - Phone:917-832-7940
Mailing Address - Fax:917-832-6864
Practice Address - Street 1:6254 97TH PL
Practice Address - Street 2:SUITE 2E
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1346
Practice Address - Country:US
Practice Address - Phone:917-832-7940
Practice Address - Fax:917-832-6864
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144431207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB88711Medicare UPIN
NY36D232Medicare ID - Type Unspecified