Healthcare Provider Details

I. General information

NPI: 1386758621
Provider Name (Legal Business Name): EILEEN LEVIN GOLDBERG APRN, GNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 PENNSYLVANIA AVE STE 105
FORT WASHINGTON PA
19034-3404
US

IV. Provider business mailing address

455 PENNSYLVANIA AVE STE 105
FORT WASHINGTON PA
19034-3404
US

V. Phone/Fax

Practice location:
  • Phone: 215-793-4546
  • Fax: 215-793-9007
Mailing address:
  • Phone: 215-793-4546
  • Fax: 215-793-9007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN774259-GNP-BC
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN246499L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number74259
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP017461
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: