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General NPI Number Information
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NPI Number | 1891823449
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Entity Type | Organization
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Legal Business Name | DR. GARY GOLDENBERG. INC
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3641 LANCASTER AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19104-2603
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Country | US
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Telephone | 215-387-1025
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Fax | 215-387-0765
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Provider Business Mailing Address
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Address Line | 3641 LANCASTER AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19104-2603
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Country | US
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Telephone | 215-387-1025
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Fax | 215-387-0765
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Authorized Official
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Title or Position | OWNER
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Name | GARY GOLDENBERG
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Credential | M.D.
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Telephone | 215-387-1025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC0051922
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS002335L
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License Number State | PA
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