Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 25MB06301800 | NJ |
NPI | 1376507814 |
---|---|
Provider Name | Dr. James Gentile |
First Address | Montclair, NJ 07042-3426 |
Second Address | Whitehouse Station, NJ 08889-3025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F23509 | (02) | NJ |