Provider Demographics
NPI:1376507814
Name:GENTILE, JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:GENTILE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 N FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3426
Mailing Address - Country:US
Mailing Address - Phone:973-233-0433
Mailing Address - Fax:973-233-0144
Practice Address - Street 1:2 SWACKHAMER RD
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE STATION
Practice Address - State:NJ
Practice Address - Zip Code:08889-3025
Practice Address - Country:US
Practice Address - Phone:908-534-8630
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06301800204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075982Medicare ID - Type Unspecified
NJF23509Medicare UPIN