Healthcare Provider Details

I. General information

NPI: 1396058251
Provider Name (Legal Business Name): GOLDEN CARE FOOT AND ANKLE SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 MAIN ST SUITE # 2
MOOSIC PA
18507-1074
US

IV. Provider business mailing address

532 MAIN STREET SUITE #2
MOOSIC PA
18507-1074
US

V. Phone/Fax

Practice location:
  • Phone: 570-457-6540
  • Fax: 570-457-6541
Mailing address:
  • Phone: 570-457-6540
  • Fax: 570-457-6541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC005994
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberSC005994
License Number StatePA

VIII. Authorized Official

Name: DR. JAN M. GOLDEN
Title or Position: PODIATRIST
Credential: D.P.M.
Phone: 570-457-6540