Provider Demographics
NPI:1457452450
Name:GOLDENS BRIDGE PEDIATRICS, PC
Entity Type:Organization
Organization Name:GOLDENS BRIDGE PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:O
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-232-2600
Mailing Address - Street 1:190 GOLDENS BRIDGE ROAD BOX 488
Mailing Address - Street 2:
Mailing Address - City:GOLDENS BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10526
Mailing Address - Country:US
Mailing Address - Phone:914-232-2600
Mailing Address - Fax:914-301-5232
Practice Address - Street 1:190 GOLDENS BRIDGE RD
Practice Address - Street 2:SUITE # 6
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-2804
Practice Address - Country:US
Practice Address - Phone:914-232-2600
Practice Address - Fax:914-301-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099591261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty