MEDICARE: PATRICK GENTEMPO JR.

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	111N00000X	Chiropractor	38MC00265100	NJ
2	111N00000X	Chiropractor	X004892-1	NY
3	111N00000X	Chiropractor	CHIR002031	GA

General Provider Information

NPI Number	:	1225586852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK GENTEMPO JR.

Provider Business Mailing Address
First Line	:	1776 PARK AVE STE 4-217
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-5148
Country	:	US
Telephone Number	:	201-345-3370
Fax Number	:

Provider Business Practice Location Address
First Line	:	1776 PARK AVE STE 4-217
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-5148
Country	:	US
Telephone Number	:	201-345-3370
Fax Number	:

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

Provider Enumeration Date	:	09/12/2016
Last Update Date	:	09/12/2016

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