MEDICARE: JEFFREY GOLD DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MB63900	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	875333CP5	OTHER	NJ	MEDICARE ID-TYPE UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104884659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY GOLD DO

Provider Business Mailing Address
First Line	:	PO BOX 416457
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-6457
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 GALLOPING HILL RD
Second Line	:	SUITE 107
City	:	UNION
State	:	NJ
Zip	:	07083-7989
Country	:	US
Telephone Number	:	908-964-7333
Fax Number	:	908-687-7855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	02/10/2016

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