Provider Demographics
NPI:1750597167
Name:IRA A. GOULD,M.D.,P.C.
Entity type:Organization
Organization Name:IRA A. GOULD,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN,PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-725-7185
Mailing Address - Street 1:365A WEST 28TH STREET
Mailing Address - Street 2:GROUND FLOOR, SUITE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7901
Mailing Address - Country:US
Mailing Address - Phone:212-725-7185
Mailing Address - Fax:212-725-7168
Practice Address - Street 1:365A WEST 28TH STREET
Practice Address - Street 2:GROUND FLOOR, SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7901
Practice Address - Country:US
Practice Address - Phone:212-725-7185
Practice Address - Fax:212-725-7168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094552207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY094552-7OtherWORKERS' COMP. BOARD
NY33D0956128OtherCLIA
NY00155633Medicaid
NY0042589OtherGHI
NY506221OtherBLUE CROSS BLUE SHIELD
NYB15655Medicare UPIN
NY506221OtherBLUE CROSS BLUE SHIELD