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NPI Code Detail

MEDICARE: DR. GARY GOLDENBERG. INC

MEDICARE: DR. GARY GOLDENBERG. INC
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
1111N00000XChiropractorDC0051922PA
2207R00000XInternal Medicine PhysicianOS002335LPA

General Provider Information

NPI Number : 1891823449
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR. GARY GOLDENBERG. INC
Provider Business Mailing Address
First Line : 3641 LANCASTER AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-2603
Country : US
Telephone Number : 215-387-1025
Fax Number : 215-387-0765
Provider Business Practice Location Address
First Line : 3641 LANCASTER AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-2603
Country : US
Telephone Number : 215-387-1025
Fax Number : 215-387-0765
Authorized Official
Title or Position : OWNER
Name : GARY GOLDENBERG
Credential : M.D.
Telephone Number : 215-387-1025
Provider Enumeration Date : 03/02/2007
Last Update Date : 09/11/2025

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