Active NPI
Jacqueline S Gomberg, M.D.
- Diagnostic Radiology Physician
- Vineland, NJ
National Provider Identifier
1285675389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 25 MA08079500
- Practice address
- 1505 W Sherman Ave
Vineland, NJ 08360-6912 - Phone
- (856) 641-7940
- Fax
- (856) 641-7657
- NPI assigned
- Jun 9, 2006
- Last updated
- Sep 18, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 25 MA08079500 | NJ | Primary |
Addresses
Primary practice location
1505 W Sherman Ave
Vineland, NJ 08360-6912
Mailing address
PO Box 228
Northfield, NJ 08225-0228
Phone (609) 641-6620
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 25MA08079500 | Other | NJ | MEDICAL LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25 MA08079500 | NJ | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221696000000",
"number": "1285675389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 228",
"city": "NORTHFIELD",
"state": "NJ",
"postal_code": "082250228",
"telephone_number": "609-641-6620",
"fax_number": "609-641-8160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1505 W SHERMAN AVE",
"city": "VINELAND",
"state": "NJ",
"postal_code": "083606912",
"telephone_number": "856-641-7940",
"fax_number": "856-641-7657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMBERG",
"first_name": "JACQUELINE",
"middle_name": "S",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-09",
"last_updated": "2008-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "NJ",
"license": "25 MA08079500",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE NUMBER",
"identifier": "25MA08079500",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vineland, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.