MEDICARE: LEE A GOLD DDS PC

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	332BC3200X	Customized Equipment (DME)
2	122300000X	Dentist

General Provider Information

NPI Number	:	1851103782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE A GOLD DDS PC

Provider Business Mailing Address
First Line	:	589 BROADWAY FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10012-3231
Country	:	US
Telephone Number	:	646-870-5652
Fax Number	:	212-219-8812

Provider Business Practice Location Address
First Line	:	589 BROADWAY FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10012-3231
Country	:	US
Telephone Number	:	646-870-5652
Fax Number	:	212-219-8812

Authorized Official
Title or Position	:	OWNER
Name	:	LEE A GOLD
Credential	:	DDS
Telephone Number	:	646-870-5652

Provider Enumeration Date	:	01/27/2025
Last Update Date	:	01/27/2025

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