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General NPI Number Information
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NPI Number | 1851705180
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Entity Type | Individual
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Provider Name | YULIYA GOMBAR D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/14/2014
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Last Update Date | 08/22/2014
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Provider Practice Location Address
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Address Line | 301 E CITY AVE STE 100
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1738
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Country | US
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Telephone | 610-771-0260
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Fax |
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Provider Business Mailing Address
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Address Line | 301 E CITY AVE
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1708
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Country | US
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Telephone | 610-617-1300
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OT015998
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License Number State | PA
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