1184668485 NPI number — GOLDSON MEDICAL ASSOCIATES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184668485 NPI number — GOLDSON MEDICAL ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDSON MEDICAL ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184668485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST ORANGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07052-0200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-313-1113
Provider Business Mailing Address Fax Number:
973-313-1191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 VALLEY ST
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
SOUTH ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07079-2887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-313-1113
Provider Business Practice Location Address Fax Number:
973-313-1191
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDSON-PROPHETE
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
NATALIA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-313-1113

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com