Healthcare Provider Details

I. General information

NPI: 1124083555
Provider Name (Legal Business Name): GARY M PRYBLICK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 HAMILTON BLVD SUITE 100
ALLENTOWN PA
18103-3691
US

IV. Provider business mailing address

3050 HAMILTON BLVD SUITE 100
ALLENTOWN PA
18103-3691
US

V. Phone/Fax

Practice location:
  • Phone: 610-437-7181
  • Fax: 610-435-0597
Mailing address:
  • Phone: 484-526-6048
  • Fax: 484-526-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS007965L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: