Provider Demographics
NPI:1568539047
Name:MICHAEL J GENTLESK MD PA
Entity Type:Organization
Organization Name:MICHAEL J GENTLESK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GENTLESK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-651-9393
Mailing Address - Street 1:2301 EVESHAM RD
Mailing Address - Street 2:STE 607
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043
Mailing Address - Country:US
Mailing Address - Phone:856-651-9393
Mailing Address - Fax:856-651-9222
Practice Address - Street 1:2301 EVESHAM RD
Practice Address - Street 2:STE 607
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-651-9393
Practice Address - Fax:856-651-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0000086930Medicare PIN
NJ0300000408Medicare PIN