Provider Demographics
NPI:1245364975
Name:GOLD, JEFFREY STUART (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STUART
Last Name:GOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JOLUDOW DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3720
Mailing Address - Country:US
Mailing Address - Phone:516-729-6255
Mailing Address - Fax:516-373-7219
Practice Address - Street 1:10 JOLUDOW DR
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-3720
Practice Address - Country:US
Practice Address - Phone:516-729-6255
Practice Address - Fax:516-373-7219
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2163782084P0800X, 2084F0202X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020-52793Medicaid
NY020-52793Medicaid