Healthcare Provider Details

I. General information

NPI: 1669129342
Provider Name (Legal Business Name): GOLD STAR PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 01/14/2023
Certification Date: 01/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3149 BOBCAT VILLAGE CENTER RD # 14
NORTH PORT FL
34288-8974
US

IV. Provider business mailing address

1400 LAKE BREEZE CT
NORTH PORT FL
34291-8023
US

V. Phone/Fax

Practice location:
  • Phone: 732-309-1292
  • Fax:
Mailing address:
  • Phone: 732-309-1292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JIGNESH BHOGILAL PATEL
Title or Position: PRESIDENT
Credential: MD
Phone: 941-266-5629