Provider Demographics
NPI:1487794368
Name:GINGOLD, LARRY W (PSYD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:W
Last Name:GINGOLD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CEDAR LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4417
Mailing Address - Country:US
Mailing Address - Phone:201-836-9430
Mailing Address - Fax:201-385-0652
Practice Address - Street 1:101 CEDAR LN
Practice Address - Street 2:SUITE 202
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4417
Practice Address - Country:US
Practice Address - Phone:201-836-9430
Practice Address - Fax:201-385-0652
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2254103TC0700X
NY7760103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ431727Medicare ID - Type Unspecified