Healthcare Provider Details

I. General information

NPI: 1609248756
Provider Name (Legal Business Name): HEATHER GENTILE RDN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 SUMMIT AVE
HACKENSACK NJ
07601-1263
US

IV. Provider business mailing address

463 1ST ST APT 5B
HOBOKEN NJ
07030-1859
US

V. Phone/Fax

Practice location:
  • Phone: 201-683-7131
  • Fax:
Mailing address:
  • Phone: 973-769-6459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER GENTILE
Title or Position: REGISTERED DIETITIAN
Credential:
Phone: 973-769-6459