Provider Demographics
NPI:1164424859
Name:GOLDEN, ELLEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
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 1:4 DEARFIELD DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5351
Mailing Address - Country:US
Mailing Address - Phone:203-622-7504
Mailing Address - Fax:203-629-6541
Practice Address - Street 1:4 DEARFIELD DR
Practice Address - Street 2:SUITE 106
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831
Practice Address - Country:US
Practice Address - Phone:203-622-7504
Practice Address - Fax:203-629-6541
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000626213E00000X, 213ES0131X
NYN005083213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
480022148OtherRAILROAD MEDICARE
NY015403940Medicaid
CT1548287519OtherMEDICARE NPI
CT004143161Medicaid
CT030000626CT01OtherANTHEM BC/BS
CTZS738OtherOXFORD
CT1548287519OtherMEDICARE
CT505409OtherAETNA US HEALTHCARE
CT01000626OtherCIGNA
CT5962075OtherAETNA
NY6200846OtherGHI
CT1548287519OtherMEDICARE NPI
CTU43725Medicare UPIN