Provider Demographics
NPI:1619206802
Name:MARION R GOLDEN ND FNP WHNP PLLC
Entity Type:Organization
Organization Name:MARION R GOLDEN ND FNP WHNP PLLC
Other - Org Name:NORTH COUNTRY FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DNP
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:631-929-9700
Mailing Address - Street 1:5976 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2001
Mailing Address - Country:US
Mailing Address - Phone:631-929-9700
Mailing Address - Fax:631-929-9702
Practice Address - Street 1:5976 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-2001
Practice Address - Country:US
Practice Address - Phone:631-929-9700
Practice Address - Fax:631-929-9702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332738261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
145219OtherVYTRA
8051992-003OtherCIGNA
9712429OtherGHI
2268928OtherUNITED HEALTHCARE
112665191OtherPHCS
NY91N081Medicare PIN
9712429OtherGHI