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General NPI Number Information
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NPI Number | 1508061318
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Entity Type | Organization
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Legal Business Name | IN HIS SHADOW FAMILY MEDICINE PC
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 11/15/2017
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Provider Practice Location Address
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Address Line | 5 GESSNER WAY
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City | NORTHUMBERLAND
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State | PA
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Zip | 17857-1535
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Country | US
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Telephone | 570-473-7017
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Fax | 570-473-7014
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Provider Business Mailing Address
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Address Line | 5 GESSNER WAY
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City | NORTHUMBERLAND
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State | PA
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Zip | 17857-1535
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Country | US
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Telephone | 570-473-7017
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Fax | 570-473-7014
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN GESSNER
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Credential | MD
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Telephone | 570-473-7017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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