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General NPI Number Information
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NPI Number | 1720543721
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Entity Type | Organization
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Legal Business Name | GOLDEN OAK MEDICAL LLC
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 334 HILLSIDE DR S
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-2720
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Country | US
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Telephone | 718-598-6808
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Fax | 770-502-6792
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Provider Business Mailing Address
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Address Line | 334 HILLSIDE DR S
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-2720
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Country | US
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Telephone | 718-598-6808
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Fax | 770-502-6792
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | KANDICE KING
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Credential |
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Telephone | 847-228-3303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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