| NPI | 1083908388 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN GERSHON SHACK Single Member LLC 610-945-5259 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD04514OL) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2011-06-03 |