Provider Information for 1114075736
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Mr. JOSEPH MACK
Sex: Male
NPI: 1114075736
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1114075736 | ||||||||
| Enumeration Date | 2007-01-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1600 GARRETT RD APT. F312 UPPER DARBY, PA 19082-4472 United States Phone: 484-454-8700 | Fax:484-454-8710 | ||||||||
| Primary Practice Address | 2000 OLD WEST CHESTER PIKE HAVERTOWN, PA 19083-2712 United States Phone: 484-454-8700 | Fax:484-454-8710 | ||||||||
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