1619206802 NPI number — MARION R GOLDEN ND FNP WHNP PLLC

Table of content: (NPI 1619206802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619206802 NPI number — MARION R GOLDEN ND FNP WHNP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARION R GOLDEN ND FNP WHNP PLLC
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:
NORTH COUNTRY FAMILY PRACTICE
Provider Other Organization Name Type Code:
3
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:
1619206802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5976 ROUTE 25A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WADING RIVER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11792-2001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-929-9700
Provider Business Mailing Address Fax Number:
631-929-9702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5976 ROUTE 25A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WADING RIVER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11792-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-929-9700
Provider Business Practice Location Address Fax Number:
631-929-9702
Provider Enumeration Date:
12/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDEN
Authorized Official First Name:
MARION
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER/DNP
Authorized Official Telephone Number:
631-929-9700

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  332738 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 145219 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8051992-003 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9712429 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2268928 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112665191 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".




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