Provider Demographics
NPI:1811389240
Name:GOLDEN MEDICAL GROUP PC
Entity Type:Organization
Organization Name:GOLDEN MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:NWOSU-NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-572-9710
Mailing Address - Street 1:9 COLLURA LN
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1659
Mailing Address - Country:US
Mailing Address - Phone:973-572-9710
Mailing Address - Fax:
Practice Address - Street 1:9 COLLURA LN
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1659
Practice Address - Country:US
Practice Address - Phone:973-572-9710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA065896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty