Provider Demographics
NPI:1184608853
Name:GOLDEN-TEVALD, JEAN MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARIE
Last Name:GOLDEN-TEVALD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:416 MECHLIN CORNER RD
Mailing Address - Street 2:
Mailing Address - City:PITTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08867-5016
Mailing Address - Country:US
Mailing Address - Phone:908-735-9344
Mailing Address - Fax:908-735-7136
Practice Address - Street 1:4 WALTER E FORAN BLVD STE 409
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4669
Practice Address - Country:US
Practice Address - Phone:908-735-9344
Practice Address - Fax:908-735-7136
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05179200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E78899Medicare UPIN
NJ1882601Medicaid