Provider Demographics
NPI:1609869668
Name:GOLD, JOAN TRUDY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:TRUDY
Last Name:GOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 34TH ST
Mailing Address - Street 2:SUITE 518
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4901
Mailing Address - Country:US
Mailing Address - Phone:212-263-6519
Mailing Address - Fax:212-263-7794
Practice Address - Street 1:400 E 34TH ST
Practice Address - Street 2:SUITE 518
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4901
Practice Address - Country:US
Practice Address - Phone:212-263-6519
Practice Address - Fax:212-263-7794
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127668174400000X, 2081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00417818Medicaid
NYCO5392Medicare UPIN
NY00417818Medicaid