Provider Demographics
NPI:1538448329
Name:GOLDEN, MICHAEL ERIC (PT DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ERIC
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 UNION RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1400
Mailing Address - Country:US
Mailing Address - Phone:716-656-8600
Mailing Address - Fax:716-656-1560
Practice Address - Street 1:350 GREENHAVEN TER
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-5547
Practice Address - Country:US
Practice Address - Phone:716-213-0772
Practice Address - Fax:716-213-0773
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY033965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1538448329Medicare PIN