Provider Demographics
NPI:1396058251
Name:GOLDEN CARE FOOT AND ANKLE SURGERY
Entity type:Organization
Organization Name:GOLDEN CARE FOOT AND ANKLE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-457-6540
Mailing Address - Street 1:532 MAIN STREET
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1074
Mailing Address - Country:US
Mailing Address - Phone:570-457-6540
Mailing Address - Fax:570-457-6541
Practice Address - Street 1:532 MAIN ST
Practice Address - Street 2:SUITE # 2
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1074
Practice Address - Country:US
Practice Address - Phone:570-457-6540
Practice Address - Fax:570-457-6541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005994332B00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024586680001Medicaid
PA1024586680001Medicaid