Provider Demographics
NPI:1003064726
Name:GOLDEN, JAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1001
Mailing Address - Country:US
Mailing Address - Phone:570-457-6540
Mailing Address - Fax:570-457-6541
Practice Address - Street 1:532 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1001
Practice Address - Country:US
Practice Address - Phone:570-457-6540
Practice Address - Fax:570-457-6541
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005994213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery