Provider Demographics
NPI:1053634436
Name:NANCY LENTINE D.O., PA
Entity Type:Organization
Organization Name:NANCY LENTINE D.O., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-237-0700
Mailing Address - Street 1:70 EAST MAIN STREET
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424
Mailing Address - Country:US
Mailing Address - Phone:973-237-0700
Mailing Address - Fax:973-237-0777
Practice Address - Street 1:70 EAST MAIN STREET
Practice Address - Street 2:1ST FLOOR
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424
Practice Address - Country:US
Practice Address - Phone:973-237-0700
Practice Address - Fax:973-237-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06165500207Q00000X
NJMB061655207Q00000X
NJ25MP00145600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty