Provider Demographics
NPI:1043103328
Name:GENTILE, GEORGIANNA EMILY (MS)
Entity type:Individual
Prefix:
First Name:GEORGIANNA
Middle Name:EMILY
Last Name:GENTILE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 S MAIN ST BLDG 2C
Mailing Address - Street 2:
Mailing Address - City:WEST CREEK
Mailing Address - State:NJ
Mailing Address - Zip Code:08092-2914
Mailing Address - Country:US
Mailing Address - Phone:609-488-2650
Mailing Address - Fax:
Practice Address - Street 1:1064 S MAIN ST BLDG 2C
Practice Address - Street 2:
Practice Address - City:WEST CREEK
Practice Address - State:NJ
Practice Address - Zip Code:08092-2914
Practice Address - Country:US
Practice Address - Phone:609-488-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-4747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist