Provider Demographics
NPI:1053405282
Name:GINGOLD, JEFFREY NEAL (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:NEAL
Last Name:GINGOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 WHISPER ROCK CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-4844
Mailing Address - Country:US
Mailing Address - Phone:775-747-9145
Mailing Address - Fax:775-747-9148
Practice Address - Street 1:1670 WHISPER ROCK CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-4844
Practice Address - Country:US
Practice Address - Phone:775-747-9145
Practice Address - Fax:775-747-9148
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5867207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016182Medicaid
NV110216401OtherRAILROAD MEDICARE
NV002016182Medicaid
NVV34384Medicare PIN