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General NPI Number Information
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NPI Number | 1689925695
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Entity Type | Organization
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Legal Business Name | DENNIS GOULD DPM PLLC
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 207 N GENEVA ST
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City | ITHACA
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State | NY
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Zip | 14850-4135
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Country | US
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Telephone | 607-272-2610
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Fax | 607-275-3266
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Provider Business Mailing Address
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Address Line | 207 N GENEVA ST
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City | ITHACA
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State | NY
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Zip | 14850-4135
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Country | US
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Telephone | 607-272-2610
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Fax | 607-275-3266
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DENNIS GOULD
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Credential | DPM
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Telephone | 607-624-4896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 004296
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License Number State | NY
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