Provider Demographics
NPI:1346752029
Name:GENTILI, JODI MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:MARIE
Last Name:GENTILI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674A 6TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6344
Mailing Address - Country:US
Mailing Address - Phone:401-714-2182
Mailing Address - Fax:
Practice Address - Street 1:369 LEXINGTON AVE FL 16
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6525
Practice Address - Country:US
Practice Address - Phone:646-861-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005539171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist