Jack Alan Gomberg, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD015248E Issued in PA

Practice address

8302 Old York Rd Ste B4
Elkins Park, PA 19027-1529

Phone

(215) 628-8585

Fax

(215) 886-1335

NPI assigned

Sep 25, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2018 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Yapa Group Therapy, Inc.

  • Clinical Psychologist
  • Chalfont, PA
  • NPI 1265473722
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680480000000",
    "number": "1114028057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 BREYER CT",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190271350",
            "telephone_number": "215-886-1335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8302 OLD YORK RD STE B4",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190271529",
            "telephone_number": "215-628-8585",
            "fax_number": "215-886-1335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMBERG",
        "first_name": "JACK",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2023-04-03",
        "certification_date": "2023-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "MD015248E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "A36474",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000839303 0003",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "000136474",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peter P Giammanco, DO
• Global Care Ambulance Transport Inc
• Monica Spokany Gocial, LCSW
• Michelle M Goldberg, PH.D.
• Nanci A Goldenberg
• Shelley Z Goodman, PHD
• Surya Gourneni, MD
• Grand Therapy Services, LLC
• Sade K Graves, LCSW
• Greater Philadelphia Oms LLC

• Psychiatry Physician in Elkins Park, PA
• Providers in Elkins Park, PA by specialty
• Psychiatry Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.