MEDICARE: JENNIFER EGLE GENTILE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1073601423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER EGLE GENTILE

Provider Business Mailing Address
First Line	:	359 W PASSAIC AVE
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-5521
Country	:	US
Telephone Number	:	917-348-8651
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 RIVER RD STE 60
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1149
Country	:	US
Telephone Number	:	917-582-3931
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	06/07/2022

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Directions to “ JENNIFER EGLE GENTILE ” Practice Location

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