Provider Demographics
NPI:1821031055
Name:GENTLESS, JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:GENTLESS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 EVESHAM ROAD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4504
Mailing Address - Country:US
Mailing Address - Phone:185-677-2111
Mailing Address - Fax:185-677-2922
Practice Address - Street 1:2301 EVESHAM ROAD
Practice Address - Street 2:SUITE 207
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4504
Practice Address - Country:US
Practice Address - Phone:185-677-2111
Practice Address - Fax:185-677-2922
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD02135213E00000X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ000046385OtherHIGHMARK BLUE SHIELD
NJ01000453900OtherAMERICHOICE
NJ0321123000OtherAMERIHEALTH
NJ5245508Medicaid
NJ5245508Medicaid
NJ046385Medicare PIN
NJ01000453900OtherAMERICHOICE