Provider Demographics
NPI:1639336241
Name:AHG1MEDICAL
Entity Type:Organization
Organization Name:AHG1MEDICAL
Other - Org Name:GOLD AMBULATORY SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:SURGEON/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-498-2800
Mailing Address - Street 1:833 NORTHERN BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5315
Mailing Address - Country:US
Mailing Address - Phone:516-498-2800
Mailing Address - Fax:516-498-2811
Practice Address - Street 1:833 NORTHERN BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5315
Practice Address - Country:US
Practice Address - Phone:516-498-2800
Practice Address - Fax:516-498-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112760261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical