Healthcare Provider Details

I. General information

NPI: 1053682187
Provider Name (Legal Business Name): GOLDEN AGE SADC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 KINGS HWY E1
BROOKLYN NY
11234-2747
US

IV. Provider business mailing address

818 RAVENS CREST DR E
PLAINSBORO NJ
08536-2465
US

V. Phone/Fax

Practice location:
  • Phone: 201-675-8754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN METELSKY
Title or Position: PRESIDENT
Credential:
Phone: 201-675-8754