Provider Demographics
NPI:1184777542
Name:GOLDEN ORTHOPAEDIC KNEE & SPORTS MEDICINE CENTER INC
Entity type:Organization
Organization Name:GOLDEN ORTHOPAEDIC KNEE & SPORTS MEDICINE CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:COGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-488-2200
Mailing Address - Street 1:9970 CENTRAL PARK BLVD N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-2231
Mailing Address - Country:US
Mailing Address - Phone:561-488-2200
Mailing Address - Fax:561-488-1064
Practice Address - Street 1:13590 JOG RD
Practice Address - Street 2:SUITE 7
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3807
Practice Address - Country:US
Practice Address - Phone:561-637-4200
Practice Address - Fax:561-637-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93605207X00000X
FLPO2578213ES0103X
FLOS4664332B00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE22131Medicare UPIN
FL0533280001Medicare NSC