Provider Demographics
NPI:1023651486
Name:GOLD, STEPHANIE E (PT)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:E
Last Name:GOLD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 WALRAVEN DR APT 2B
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5120
Mailing Address - Country:US
Mailing Address - Phone:410-370-2777
Mailing Address - Fax:
Practice Address - Street 1:611 N MAPLE AVE STE 6
Practice Address - Street 2:
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1668
Practice Address - Country:US
Practice Address - Phone:201-447-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01881300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist