Healthcare Provider Details

I. General information

NPI: 1265448674
Provider Name (Legal Business Name): ANDREA GOLD AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT. 9D VAHVHVS CASTLE POINT CAMPUS
CASTLE POINT NY
12511
US

IV. Provider business mailing address

14 VAN BUREN CT
HIGHLAND MILLS NY
10930-2701
US

V. Phone/Fax

Practice location:
  • Phone: 845-838-5226
  • Fax: 845-838-5266
Mailing address:
  • Phone: 914-843-8597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001195-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: