Provider Demographics
NPI:1386758621
Name:LEVIN GOLDBERG, EILEEN (APRN, GNP-BC)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:LEVIN GOLDBERG
Suffix:
Gender:F
Credentials:APRN, GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 PENNSYLVANIA AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3404
Mailing Address - Country:US
Mailing Address - Phone:215-793-4546
Mailing Address - Fax:215-793-9007
Practice Address - Street 1:455 PENNSYLVANIA AVE STE 105
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3404
Practice Address - Country:US
Practice Address - Phone:215-793-4546
Practice Address - Fax:215-793-9007
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN774259-GNP-BC363LG0600X
PARN246499L364SP0808X
WV74259364SP0808X
PASP017461363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA770363Medicare PIN
WV770363Medicare PIN
WVS14051Medicare UPIN
PA770363JM2Medicare ID - Type UnspecifiedEIL MED#
PAS14051Medicare UPIN