Provider Demographics
NPI:1114960077
Name:GOLDEN, SETH (DPM)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WREN DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2722
Mailing Address - Country:US
Mailing Address - Phone:718-544-7575
Mailing Address - Fax:
Practice Address - Street 1:38 WREN DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2722
Practice Address - Country:US
Practice Address - Phone:718-544-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO5277-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01779340Medicaid
NY01779340Medicaid
NYPG7391Medicare PIN
NYU66207Medicare UPIN
NYP94611Medicare PIN