Provider Demographics
NPI:1053347385
Name:GOLER, SCOTT ALAN (DPM)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
Last Name:GOLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:664 ALANON RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-5326
Mailing Address - Country:US
Mailing Address - Phone:973-779-7400
Mailing Address - Fax:973-779-7460
Practice Address - Street 1:1 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-2235
Practice Address - Country:US
Practice Address - Phone:973-779-7400
Practice Address - Fax:973-779-7460
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MD00220600213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1056340001Medicare NSC