Healthcare Provider Details

I. General information

NPI: 1326091562
Provider Name (Legal Business Name): NINA AVIVA GOLD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 CLINTON STREET
PATERSON NJ
07522
US

IV. Provider business mailing address

PATERSON COMMUNITY HEALTH CENTER 32 CLINTON ST
PATERSON NJ
07522
US

V. Phone/Fax

Practice location:
  • Phone: 973-790-6594
  • Fax: 973-389-2197
Mailing address:
  • Phone: 973-790-6594
  • Fax: 973-389-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA05248200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number6348200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: