Individual
DAVID SHACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AGPCNP-BC
Contact information
Practice address
75 MAIDEN LN, STE 1206, NEW YORK, NY 10038-4810
(212) 995-6495
(212) 379-6486
Mailing address
75 MAIDEN LN, STE 1206, NEW YORK, NY 10038-4810
(212) 995-6495
(212) 379-6486
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F307993
NY
Other
Enumeration date
09/12/2016
Last updated
04/05/2017
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