Individual
JACQUELINE S GOMBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1505 W SHERMAN AVE, VINELAND, NJ 08360-6912
(856) 641-7940
(856) 641-7657
Mailing address
PO BOX 228, NORTHFIELD, NJ 08225-0228
(609) 641-6620
(609) 641-8160
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
25 MA08079500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA08079500
MEDICAL LICENSE NUMBER
NJ
Enumeration date
06/09/2006
Last updated
09/18/2008
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