Provider Demographics
NPI:1598451700
Name:PENTO, JESSE ROBERT
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:ROBERT
Last Name:PENTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 GLENN SMITH RD
Mailing Address - Street 2:
Mailing Address - City:LAKE LYNN
Mailing Address - State:PA
Mailing Address - Zip Code:15451-1074
Mailing Address - Country:US
Mailing Address - Phone:724-970-8676
Mailing Address - Fax:724-437-2629
Practice Address - Street 1:54A LEBANON AVE
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-4127
Practice Address - Country:US
Practice Address - Phone:724-322-1683
Practice Address - Fax:724-437-2629
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16773601374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide