Healthcare Provider Details

I. General information

NPI: 1215360953
Provider Name (Legal Business Name): ELIZABETH ANN GOLD APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE FL 5
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

1005 TOMPKINS AVE
SOUTH PLAINFIELD NJ
07080-2238
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-5914
  • Fax: 908-522-5845
Mailing address:
  • Phone: 908-406-5206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ00454100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: