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Organization
CAMP SHANE
Active
Organization
CAMP SHANE
Active
Parent organization
SHANE FIT
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHANE FIT
Authorized official
DAVID ETTENBERG M.D. (OWNER)
(626) 797-9977
Entity
Organization
Contact information
Practice address
134 TEATOWN RD, CROTON ON HUDSON, NY 10520-3524
(626) 797-9977
Mailing address
134 TEATOWN RD, CROTON ON HUDSON, NY 10520-3524
(626) 797-9977
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
R049213-1
NY
Other
Enumeration date
05/03/2012
Last updated
05/03/2012
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