Healthcare Provider Details

I. General information

NPI: 1386722791
Provider Name (Legal Business Name): JEROLD R GOLD PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N STATION PLZ STE 301
GREAT NECK NY
11021-5007
US

IV. Provider business mailing address

45 N STATION PLZ STE 301
GREAT NECK NY
11021-5007
US

V. Phone/Fax

Practice location:
  • Phone: 516-238-9063
  • Fax: 516-629-6882
Mailing address:
  • Phone: 516-238-9063
  • Fax: 516-629-6882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number006965
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: