Healthcare Provider Details

I. General information

NPI: 1053634436
Provider Name (Legal Business Name): NANCY LENTINE D.O., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 EAST MAIN STREET 1ST FLOOR
LITTLE FALLS NJ
07424
US

IV. Provider business mailing address

70 EAST MAIN STREET 1ST FLOOR
LITTLE FALLS NJ
07424
US

V. Phone/Fax

Practice location:
  • Phone: 973-237-0700
  • Fax: 973-237-0777
Mailing address:
  • Phone: 973-237-0700
  • Fax: 973-237-0777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB06165500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00145600
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB061655
License Number StateNJ

VIII. Authorized Official

Name: NANCY LENTINE
Title or Position: OWNER/PHYSICIAN
Credential: D.O.
Phone: 973-237-0700