Healthcare Provider Details

I. General information

NPI: 1518611292
Provider Name (Legal Business Name): GENTLE SWAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6134 N BERNARD ST
CHICAGO IL
60659-2212
US

IV. Provider business mailing address

6134 N BERNARD ST
CHICAGO IL
60659-2212
US

V. Phone/Fax

Practice location:
  • Phone: 732-330-6304
  • Fax:
Mailing address:
  • Phone: 732-330-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: ARON MOORE
Title or Position: PRESIDENT
Credential:
Phone: 732-330-6304