Basic Information
| Provider Information | |||||||||
| NPI: | 1568424448 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOOBERMAN | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 402 LIPPINCOTT DR | ||||||||
| Address2: | |||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080534112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567823300 | ||||||||
| FaxNumber: | 8565048029 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 S CENTRE ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MERCHANTVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081092213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566657337 | ||||||||
| FaxNumber: | 8566658246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 05/26/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25MA04585200 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.