Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | F000657 | NY |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 402968 | NY |
NPI | 1083641203 |
---|---|
Provider Name | Julie Gold |
First Address | Brooklyn, NY 11215-4201 |
Second Address | Brooklyn, NY 11215-4201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 10/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1779771 | (05) | NY |
S49974 | (02) |