MEDICARE: DR. NANCY JACOBS GOLDENBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD024196E	PA
2	2085R0202X	Diagnostic Radiology Physician	MD024196E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841297736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY JACOBS GOLDENBERG M.D.

Provider Business Mailing Address
First Line	:	101 GREENWOOD AVE
Second Line	:	SUITE 150
City	:	JENKINTOWN
State	:	PA
Zip	:	19046-2627
Country	:	US
Telephone Number	:	215-379-8458
Fax Number	:	215-379-8461

Provider Business Practice Location Address
First Line	:	1619 GRANT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-3167
Country	:	US
Telephone Number	:	215-934-6100
Fax Number	:	215-934-6713

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	04/25/2014

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