Provider Demographics
NPI:1891823449
Name:DR. GARY GOLDENBERG. INC
Entity Type:Organization
Organization Name:DR. GARY GOLDENBERG. INC
Other - Org Name:UNIVERSITY CITY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-387-1025
Mailing Address - Street 1:3641 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2603
Mailing Address - Country:US
Mailing Address - Phone:215-387-1025
Mailing Address - Fax:215-387-0765
Practice Address - Street 1:3641 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2603
Practice Address - Country:US
Practice Address - Phone:215-387-1025
Practice Address - Fax:215-387-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC0051922111N00000X
PAOS002335L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty