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1629066626
JONATHAN SHACK
PHILADELPHIA, PA
NPI
1629066626
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2084P0800X Psychiatry & Neurology, Psychiatry
(Licence: PA MD045140L)
Enumeration Date
2005-10-12
Last Update Date
2007-07-08
Business Address
-- JONATHAN SHACK MD
100 E LEHIGH AVE MAB BLDG STE 105
PHILADELPHIA, PA 19125-1000
Phone number: 215-707-8496
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Mailing Address
-- JONATHAN SHACK MD
3425 N CARLISLE ST 2ND FLOOR HUDSON BLDG
PHILADELPHIA, PA 19140-5108
Phone number: 215-707-4739
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