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General NPI Number Information
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NPI Number | 1194998682
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Entity Type | Individual
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Provider Name | LANCE L GOOBERMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 1 S CENTRE ST #201
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City | MERCHANTVILLE
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State | NJ
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Zip | 08109-2213
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Country | US
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Telephone | 856-663-4447
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Fax | 856-488-6380
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Provider Business Mailing Address
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Address Line | 1 S CENTRE ST #201
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City | MERCHANTVILLE
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State | NJ
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Zip | 08109-2213
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Country | US
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Telephone | 856-663-4447
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Fax | 856-488-6380
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 25MA03819100
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License Number State | NJ
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