Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | N004296-1 | NY |
N | 213ES0103X | Foot & Ankle Surgery | SC005885 | PA |
NPI | 1508083163 |
---|---|
Provider Name | Dr. Dennis Jay Gould |
First Address | Binghamton, NY 13903 |
Second Address | Ithaca, NY 14850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 05/11/2012 |