Provider Demographics
NPI:1508617283
Name:IMPAK PSYCHIATRY
Entity Type:Organization
Organization Name:IMPAK PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-486-7722
Mailing Address - Street 1:PO BOX 52374
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-7374
Mailing Address - Country:US
Mailing Address - Phone:267-715-2089
Mailing Address - Fax:267-361-1300
Practice Address - Street 1:1301 VIRGINIA DR STE 400
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3243
Practice Address - Country:US
Practice Address - Phone:267-715-2089
Practice Address - Fax:267-361-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty