Healthcare Provider Details

I. General information

NPI: 1447606744
Provider Name (Legal Business Name): HENRY GURSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BROOKSIDE RD STE 302
ALLENTOWN PA
18106-9042
US

IV. Provider business mailing address

619 SPRINGHOUSE RD APT G
ALLENTOWN PA
18104-4697
US

V. Phone/Fax

Practice location:
  • Phone: 610-704-9328
  • Fax:
Mailing address:
  • Phone: 610-704-9328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPS005634L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS005634L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: