Healthcare Provider Details

I. General information

NPI: 1376834309
Provider Name (Legal Business Name): DANIEL SETH GINGOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 05/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1378 3RD AVE APT 3C
NEW YORK NY
10075-0457
US

IV. Provider business mailing address

16311 VENTURA BLVD STE 505
ENCINO CA
91436-4309
US

V. Phone/Fax

Practice location:
  • Phone: 917-509-5256
  • Fax:
Mailing address:
  • Phone: 917-509-5256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number259877
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA116809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: