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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