Provider Demographics
NPI:1720543721
Name:GOLDEN OAK MEDICAL LLC
Entity Type:Organization
Organization Name:GOLDEN OAK MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-228-3303
Mailing Address - Street 1:334 HILLSIDE DR S
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2720
Mailing Address - Country:US
Mailing Address - Phone:718-598-6808
Mailing Address - Fax:770-502-6792
Practice Address - Street 1:334 HILLSIDE DR S
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2720
Practice Address - Country:US
Practice Address - Phone:718-598-6808
Practice Address - Fax:770-502-6792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty