Provider Demographics
NPI:1073601423
Name:GENTILE, JENNIFER EGLE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EGLE
Last Name:GENTILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:EGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:359 W PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5521
Mailing Address - Country:US
Mailing Address - Phone:917-348-8651
Mailing Address - Fax:
Practice Address - Street 1:725 RIVER RD STE 60
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1149
Practice Address - Country:US
Practice Address - Phone:917-582-3931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist