Provider Demographics
NPI:1124083555
Name:PRYBLICK, GARY M (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:PRYBLICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3050 HAMILTON BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3691
Mailing Address - Country:US
Mailing Address - Phone:484-526-6048
Mailing Address - Fax:484-526-6500
Practice Address - Street 1:3050 HAMILTON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3691
Practice Address - Country:US
Practice Address - Phone:610-437-7181
Practice Address - Fax:610-435-0597
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS007965L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF37685Medicare UPIN
PA102003Medicare ID - Type UnspecifiedMEDICARE