Provider Demographics
NPI:1053350447
Name:GOLD, CAROLE VICKI (PT, MA)
Entity type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:VICKI
Last Name:GOLD
Suffix:
Gender:F
Credentials:PT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WOODY PL
Mailing Address - Street 2:
Mailing Address - City:MT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-1747
Mailing Address - Country:US
Mailing Address - Phone:631-928-8098
Mailing Address - Fax:631-928-8016
Practice Address - Street 1:11 WOODY PL
Practice Address - Street 2:
Practice Address - City:MT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-1747
Practice Address - Country:US
Practice Address - Phone:631-928-8098
Practice Address - Fax:631-928-8016
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002534-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ01081Medicare ID - Type UnspecifiedPHYSICAL THERAPY PROVIDER