Provider Demographics
NPI:1669129342
Name:GOLD STAR PEDIATRICS PA
Entity type:Organization
Organization Name:GOLD STAR PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIGNESH
Authorized Official - Middle Name:BHOGILAL
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-266-5629
Mailing Address - Street 1:1400 LAKE BREEZE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34291-8023
Mailing Address - Country:US
Mailing Address - Phone:732-309-1292
Mailing Address - Fax:
Practice Address - Street 1:3149 BOBCAT VILLAGE CENTER RD # 14
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34288-8974
Practice Address - Country:US
Practice Address - Phone:732-309-1292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1003082280OtherNPI
FL281244400Medicaid