Healthcare Provider Details

I. General information

NPI: 1821060187
Provider Name (Legal Business Name): VICTOR GERARD GENTILE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 BILBY RD SUITE 301
HACKETTSTOWN NJ
07840-4174
US

IV. Provider business mailing address

108 BILBY RD SUITE 301
HACKETTSTOWN NJ
07840-4174
US

V. Phone/Fax

Practice location:
  • Phone: 908-979-0662
  • Fax: 908-979-0713
Mailing address:
  • Phone: 908-979-0662
  • Fax: 908-979-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMA63710
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: