Provider Demographics
NPI:1780727461
Name:JODILYN GINGOLD M. D.,P. C.
Entity type:Organization
Organization Name:JODILYN GINGOLD M. D.,P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JODILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-544-7752
Mailing Address - Street 1:7010 AUSTIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4763
Mailing Address - Country:US
Mailing Address - Phone:718-544-7753
Mailing Address - Fax:718-544-7752
Practice Address - Street 1:7010 AUSTIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4763
Practice Address - Country:US
Practice Address - Phone:718-544-7753
Practice Address - Fax:718-544-7752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144431207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDP052OtherOXFORD
NY244AJ2OtherEMPIRE BCBS-F. HILLS
NY0347515005OtherCIGNA
NM244AJ3OtherEMPIRE BCBS-LAKE SUCCESS
NY244AJ2OtherEMPIRE BCBS-F. HILLS
NY0347515005OtherCIGNA