Provider Demographics
NPI:1871670109
Name:GOLD, CORY W (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:W
Last Name:GOLD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0913
Mailing Address - Country:US
Mailing Address - Phone:212-249-6767
Mailing Address - Fax:212-861-4769
Practice Address - Street 1:1020 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0913
Practice Address - Country:US
Practice Address - Phone:212-249-6767
Practice Address - Fax:212-861-4769
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX18411Medicare ID - Type Unspecified
NYX18411Medicare UPIN