Provider Demographics
NPI:1053682187
Name:GOLDEN AGE SADC
Entity Type:Organization
Organization Name:GOLDEN AGE SADC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:METELSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-675-8754
Mailing Address - Street 1:818 RAVENS CREST DR E
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-2465
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3601 KINGS HWY
Practice Address - Street 2:E1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2747
Practice Address - Country:US
Practice Address - Phone:201-675-8754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care