NPIMap

Organization Active NPI

Joel S. Goldberg

  • Family Medicine Physician
  • Boothwyn, PA
National Provider Identifier
1972704971
Registry record updated Jan 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS004415L Issued in PA
Legal business name
JOEL S. GOLDBERG
Practice address
4015 Chichester Ave
Boothwyn, PA 19061
Phone
(610) 404-4422
NPI assigned
May 29, 2007
Last updated
Jan 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2008

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

Authorized official

Name
Joel S. GoldbergNPI 1699714402
Title
Owner
Phone
(610) 494-4422

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS004415L PA Primary

Addresses

Primary practice location

4015 Chichester Ave
Boothwyn, PA 19061

Mailing address

4015 Chichester Ave
Boothwyn, PA 19061
Phone (610) 404-4422

Other identifiers 1

IdentifierTypeStateIssuer
0016128870002MedicaidPA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0196841Joel S Goldberg Dr4015 Chichester Ave, Boothwyn, PA 19061Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

4015 Chichester Ave
Upper Chichester, PA 19061
Phone (610) 494-4422

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201478400000",
    "number": "1972704971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4015 CHICHESTER AVE",
            "city": "BOOTHWYN",
            "state": "PA",
            "postal_code": "19061",
            "telephone_number": "610-404-4422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4015 CHICHESTER AVE",
            "city": "BOOTHWYN",
            "state": "PA",
            "postal_code": "19061",
            "telephone_number": "610-404-4422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOEL S. GOLDBERG",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2008-01-28",
        "status": "A",
        "authorized_official_last_name": "GOLDBERG",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-494-4422"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS004415L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0016128870002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boothwyn, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.