Healthcare Provider Details

I. General information

NPI: 1831252642
Provider Name (Legal Business Name): THOMAS GOLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W RIDGEWOOD AVE SUITE 209
PARAMUS NJ
07652-2359
US

IV. Provider business mailing address

1 W RIDGEWOOD AVE SUITE 209
PARAMUS NJ
07652-2359
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-5744
  • Fax: 201-444-8990
Mailing address:
  • Phone: 201-444-5744
  • Fax: 201-444-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMA49967
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier03520830374
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerM.E. NUMBER
# 2
Identifier5085705
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: