Provider Demographics
NPI:1588710982
Name:GOLDSEN, SILIA MARJORIE (MD)
Entity type:Individual
Prefix:MRS
First Name:SILIA
Middle Name:MARJORIE
Last Name:GOLDSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4008
Mailing Address - Country:US
Mailing Address - Phone:718-499-6099
Mailing Address - Fax:718-499-6391
Practice Address - Street 1:362 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4008
Practice Address - Country:US
Practice Address - Phone:718-499-6099
Practice Address - Fax:718-499-6391
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194417-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01545422Medicaid
NY01545422Medicaid
NY03088Medicare ID - Type Unspecified