Basic Information
| Provider Information | |||||||||
| NPI: | 1083236897 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GOLDBERG | ||||||||
| FirstName: | CORA | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 W HARMONY RD | ||||||||
| Address2: | |||||||||
| City: | WEST GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193901013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109065155 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1096 OLD CHURCHMANS RD | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026559494 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2020 | ||||||||
| LastUpdateDate: | 05/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | RT005354 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 2255A2300X | J3-0000434 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.