1700991114 NPI number — DR. JEFFREY GOLD O.D.

Table of content: DR. JEFFREY GOLD O.D. (NPI 1700991114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700991114 NPI number — DR. JEFFREY GOLD O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLD
Provider First Name:
JEFFREY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
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:
1700991114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
504 NEWPORT CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANGHORNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19053-2489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-355-6471
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 BUSTLETON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FEASTERVILLE TREVOSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19053-6448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-355-1300
Provider Business Practice Location Address Fax Number:
215-355-8745
Provider Enumeration Date:
08/19/2006

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: 152W00000X , with the licence number:  OEG-000757 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0558984000 . This is a "KEYSTONE HPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 119455TNB . This is a "NOVITAS SOLUTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01301081 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5902T . This is a "VISION BENEFITS OF AMERIC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 32276 . This is a "DAVIS VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 55779 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3982183 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 171080 . This is a "BUDD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000119455 . This is a "IBX-HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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