Provider Demographics
NPI:1184796310
Name:GOLD, RICHARD SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SAMUEL
Last Name:GOLD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1010 NORTHERN BLVD STE 328
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5329
Mailing Address - Country:US
Mailing Address - Phone:516-233-2484
Mailing Address - Fax:516-304-5850
Practice Address - Street 1:215 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2807
Practice Address - Country:US
Practice Address - Phone:631-265-5858
Practice Address - Fax:631-265-5756
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2024-10-23
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Provider Licenses
StateLicense IDTaxonomies
NY168856207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA60945Medicare UPIN