Provider Demographics
NPI:1588044697
Name:JODI M GENTILI
Entity Type:Organization
Organization Name:JODI M GENTILI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:M
Authorized Official - Last Name:GENTILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-714-2182
Mailing Address - Street 1:301 VANDERBILT AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3604
Mailing Address - Country:US
Mailing Address - Phone:401-714-2182
Mailing Address - Fax:212-223-0198
Practice Address - Street 1:301 VANDERBILT AVE
Practice Address - Street 2:APT 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3604
Practice Address - Country:US
Practice Address - Phone:401-714-2182
Practice Address - Fax:212-223-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005539261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain