Lance L Gooberman, M.D.

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

License

25MA03819100 Issued in NJ

Practice address

1 S Centre St
#201
Merchantville, NJ 08109-2213

Phone

(856) 663-4447

Fax

(856) 488-6380

NPI assigned

Apr 7, 2008

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

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, 2020 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1207526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207526400000",
    "number": "1194998682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 S CENTRE ST",
            "address_2": "#201",
            "city": "MERCHANTVILLE",
            "state": "NJ",
            "postal_code": "081092213",
            "telephone_number": "856-663-4447",
            "fax_number": "856-488-6380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 S CENTRE ST",
            "address_2": "#201",
            "city": "MERCHANTVILLE",
            "state": "NJ",
            "postal_code": "081092213",
            "telephone_number": "856-663-4447",
            "fax_number": "856-488-6380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOOBERMAN",
        "first_name": "LANCE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-07",
        "last_updated": "2008-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "NJ",
            "license": "25MA03819100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keely Fruin
• Gilliss Family Care,LLC
• Adam C. Gilliss, D.O.
• Christine Gilliss, MA, CCC-SLP
• Bruce D Gooberman, MD
• Gregory Hample
• Hands of Healing and Harmony LLC
• Esther R Harris, MD
• Virginia Hedges, MA CCC-SLP
• Houtaneh Houtan, NMD

• Addiction Medicine (Internal Medicine) Physician in Merchantville, NJ
• Providers in Merchantville, NJ by specialty
• Addiction Medicine (Internal Medicine) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2008; 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.