Provider Demographics
NPI:1174566244
Name:GOLD, MICHAEL B (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:GOLD
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 1:5515 LITTLE NECK PKWY
Mailing Address - Street 2:SUITE L10
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2244
Mailing Address - Country:US
Mailing Address - Phone:631-265-8780
Mailing Address - Fax:
Practice Address - Street 1:5515 LITTLE NECK PKWY
Practice Address - Street 2:SUITE L10
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-2244
Practice Address - Country:US
Practice Address - Phone:631-265-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156092207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20865GMedicare PIN