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General NPI Number Information
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NPI Number | 1114461761
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Entity Type | Organization
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Legal Business Name | LISA G. GOLD, FAMILY HEALTH NP, PLLC
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Dates
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Enumeration Date | 12/15/2016
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 2-4 AUSTIN COURT
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City | POUGHKEEPSIE
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State | NY
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Zip | 12603
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Country | US
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Telephone | 845-654-0506
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Fax |
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Provider Business Mailing Address
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Address Line | 79 DYKEMAN RD
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City | CARMEL
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State | NY
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Zip | 10512-5047
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Country | US
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Telephone | 845-216-0790
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LISA GOLD
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Credential | FNP
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Telephone | 845-654-0506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 331534
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License Number State | NY
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