Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jonathan Shack, MD

Individual provider Psychiatry Physician · NPI 1629066626

Jonathan Shack, MD is a Psychiatry in Philadelphia, Pennsylvania. Qualified in 1989, 37 years ago. Practices with Eastern Pennsylvania Physician Alliance, LLC, a 110-clinician group and accepts Medicare assignment. Licensed in Pennsylvania.

Years since qualifying
37
Licensed in
PA
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

100 E Lehigh Ave Mab Bldg Ste 105
Philadelphia, PA 19125-1000
Phone: (215) 707-8496
Fax: (215) 707-4086
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X · Licence MD045140L (PA)

Record details

NPI number1629066626
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedOctober 12, 2005
Last updated in NPPESJuly 13, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPSYCHIATRY
Medical schoolOTHER
Graduated 1989 (37 years in practice)
Group practice Eastern Pennsylvania Physician Alliance, Llc — 110 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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