Healthcare Provider Details

I. General information

NPI: 1285722637
Provider Name (Legal Business Name): GENA LENTZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 NEWARK POMPTON TPKE
RIVERDALE NJ
07957
US

IV. Provider business mailing address

18 NEWARK POMPTON TPKE
RIVERDALE NJ
07957
US

V. Phone/Fax

Practice location:
  • Phone: 973-676-8300
  • Fax: 973-616-9314
Mailing address:
  • Phone: 973-676-8300
  • Fax: 973-616-9314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number40QA01152400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: