Provider Demographics
NPI:1588715684
Name:GOLDEN GERIATRICS
Entity type:Organization
Organization Name:GOLDEN GERIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:914-301-5044
Mailing Address - Street 1:3 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOLDENS BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10526-1129
Mailing Address - Country:US
Mailing Address - Phone:914-301-5044
Mailing Address - Fax:914-366-0641
Practice Address - Street 1:200 S BROADWAY
Practice Address - Street 2:SUITE 106
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-4500
Practice Address - Country:US
Practice Address - Phone:914-366-6821
Practice Address - Fax:914-366-0641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430089174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0599G1Medicare UPIN
NYQ16816Medicare UPIN
NYI02730Medicare UPIN