Healthcare Provider Details

I. General information

NPI: 1497804231
Provider Name (Legal Business Name): GOLD CHRIS ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTRE ST.
OCEAN NJ
07712
US

IV. Provider business mailing address

P.O. BOX 2136 1 CENTRE STREET
OCEAN NJ
07712
US

V. Phone/Fax

Practice location:
  • Phone: 732-922-0591
  • Fax: 732-922-0593
Mailing address:
  • Phone: 732-922-0591
  • Fax: 732-922-0593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number10129-02-05
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY I GOLDSTEIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: J.D. - MBA
Phone: 732-922-0591