1518064427 NPI number — HENRY GOLD

Table of content: HENRY GOLD (NPI 1518064427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518064427 NPI number — HENRY GOLD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLD
Provider First Name:
HENRY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518064427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
291 MOODY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUDLOW
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01056-1246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-664-5279
Provider Business Mailing Address Fax Number:
413-589-7554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 HOSPITAL AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH ADAMS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-664-5279
Provider Business Practice Location Address Fax Number:
413-589-7554
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  39856 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: J07411 . This is a "BC BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1003886 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3035999 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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