Provider Demographics
NPI:1821851007
Name:GOLD, SHIFRA
Entity Type:Individual
Prefix:MRS
First Name:SHIFRA
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 N ALTA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-1963
Mailing Address - Country:US
Mailing Address - Phone:973-955-9682
Mailing Address - Fax:
Practice Address - Street 1:250 UTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3931
Practice Address - Country:US
Practice Address - Phone:718-925-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator