Provider Demographics
NPI:1942351929
Name:REHAK, NATALIE TASKA (PSYD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:TASKA
Last Name:REHAK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 HUNTINGDON PIKE
Mailing Address - Street 2:
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8004
Mailing Address - Country:US
Mailing Address - Phone:215-968-9380
Mailing Address - Fax:215-968-9385
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8004
Practice Address - Country:US
Practice Address - Phone:215-968-9380
Practice Address - Fax:215-968-9385
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015668103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA090198RCDMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER