Individual
DR. JACK ALAN GOMBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8302 OLD YORK RD STE B4, ELKINS PARK, PA 19027-1529
(215) 628-8585
(215) 886-1335
Mailing address
16 BREYER CT, ELKINS PARK, PA 19027-1350
(215) 886-1335
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD015248E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000136474
HIGHMARK BLUE SHIELD
PA
05
—
000839303 0003
—
PA
01
—
A36474
AMERIHEALTH
PA
Enumeration date
09/25/2006
Last updated
04/03/2023
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