MEDICARE: DR. CORY W GOLD DC

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	111N00000X	Chiropractor	X3042	NY

General Provider Information

NPI Number	:	1871670109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORY W GOLD DC

Provider Business Mailing Address
First Line	:	1020 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-0913
Country	:	US
Telephone Number	:	212-249-6767
Fax Number	:	212-861-4769

Provider Business Practice Location Address
First Line	:	1020 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-0913
Country	:	US
Telephone Number	:	212-249-6767
Fax Number	:	212-861-4769

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/05/2008

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Directions to “ DR. CORY W GOLD DC” Practice Location

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