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General NPI Number Information
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NPI Number | 1225219348
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Entity Type | Organization
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Legal Business Name | GOMBERG PSYCHIATRIC ASSOCIATES, INC.
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 748 N BETHLEHEM PIKE
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City | SPRING HOUSE
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State | PA
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Zip | 19477-1013
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Country | US
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Telephone | 215-628-8585
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Fax | 215-247-4404
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Provider Business Mailing Address
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Address Line | PO BOX 246
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City | SPRING HOUSE
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State | PA
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Zip | 19477-0246
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Country | US
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Telephone | 215-628-8585
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Fax | 215-247-4404
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACK ALAN GOMBERG
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Credential | M.D.
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Telephone | 215-628-8585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD015248E
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License Number State | PA
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