Provider Demographics
NPI:1720180524
Name:GOMBERG, MASON BARNETT (MD)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:BARNETT
Last Name:GOMBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3312
Mailing Address - Country:US
Mailing Address - Phone:914-984-0353
Mailing Address - Fax:914-948-5237
Practice Address - Street 1:410 N BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-3312
Practice Address - Country:US
Practice Address - Phone:914-984-0353
Practice Address - Fax:914-948-5237
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156794208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics