Provider Demographics
NPI:1225219348
Name:GOMBERG PSYCHIATRIC ASSOCIATES, INC.
Entity Type:Organization
Organization Name:GOMBERG PSYCHIATRIC ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GOMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-628-8585
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:SPRING HOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:19477-0246
Mailing Address - Country:US
Mailing Address - Phone:215-628-8585
Mailing Address - Fax:215-247-4404
Practice Address - Street 1:748 N BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477-1013
Practice Address - Country:US
Practice Address - Phone:215-628-8585
Practice Address - Fax:215-247-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015248E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB34411Medicare UPIN
PA136474Medicare PIN