Provider Demographics
NPI:1497150023
Name:GOMBERG, JUDAH M (DPM)
Entity Type:Individual
Prefix:DR
First Name:JUDAH
Middle Name:M
Last Name:GOMBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14725 72ND AVE APT A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2543
Mailing Address - Country:US
Mailing Address - Phone:917-613-7388
Mailing Address - Fax:
Practice Address - Street 1:14725 72ND AVE APT A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2543
Practice Address - Country:US
Practice Address - Phone:917-613-7388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006703213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery