MEDICARE: DIANA M GONZALEZ-GOLDEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	344197	NY

General Provider Information

NPI Number	:	1811692155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA M GONZALEZ-GOLDEN MD

Provider Business Mailing Address
First Line	:	14 WASHINGTON ST
Second Line	:
City	:	HICKSVILLE
State	:	NY
Zip	:	11801-3730
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3907
Country	:	US
Telephone Number	:	347-349-5007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	06/08/2026

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