Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 25MA02045200 | NJ |
NPI | 1083899645 |
---|---|
Provider Name | Dr. Michael John Gentlesk |
First Address | Voorhees, NJ 08043-4501 |
Second Address | Voorhees, NJ 08043-4501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2008 |
Last Update Date | 02/01/2008 |