Provider Demographics
NPI:1811779234
Name:GOLDEN, ROBERT MATTHEW (PA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MATTHEW
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 LAKEWOOD CT APT 18
Mailing Address - Street 2:
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955-2016
Mailing Address - Country:US
Mailing Address - Phone:631-690-0471
Mailing Address - Fax:
Practice Address - Street 1:69 LAKEWOOD CT APT 18
Practice Address - Street 2:
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955-2016
Practice Address - Country:US
Practice Address - Phone:631-690-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001633-01363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical