Healthcare Provider Details

I. General information

NPI: 1184777542
Provider Name (Legal Business Name): GOLDEN ORTHOPAEDIC KNEE & SPORTS MEDICINE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13590 JOG RD SUITE 7
DELRAY BEACH FL
33446-3807
US

IV. Provider business mailing address

9970 CENTRAL PARK BLVD N SUITE 300
BOCA RATON FL
33428-2231
US

V. Phone/Fax

Practice location:
  • Phone: 561-637-4200
  • Fax: 561-637-3222
Mailing address:
  • Phone: 561-488-2200
  • Fax: 561-488-1064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOS4664
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME93605
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberOS4664
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2578
License Number StateFL

VIII. Authorized Official

Name: DAWN COGEN
Title or Position: AO
Credential:
Phone: 561-488-2200