Healthcare Provider Details

I. General information

NPI: 1689925695
Provider Name (Legal Business Name): DENNIS GOULD DPM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N GENEVA ST
ITHACA NY
14850-4135
US

IV. Provider business mailing address

207 N GENEVA ST
ITHACA NY
14850-4135
US

V. Phone/Fax

Practice location:
  • Phone: 607-272-2610
  • Fax: 607-275-3266
Mailing address:
  • Phone: 607-272-2610
  • Fax: 607-275-3266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number004296
License Number StateNY

VIII. Authorized Official

Name: DENNIS GOULD
Title or Position: SOLE MEMBER
Credential: DPM
Phone: 607-624-4896