Healthcare Provider Details

I. General information

NPI: 1902081623
Provider Name (Legal Business Name): DR. MARK LENTINI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 WESTERN AVE
ALBANY NY
12203-5066
US

IV. Provider business mailing address

1971 WESTERN AVE
ALBANY NY
12203-5066
US

V. Phone/Fax

Practice location:
  • Phone: 518-456-2014
  • Fax: 518-862-9046
Mailing address:
  • Phone: 518-456-2014
  • Fax: 518-862-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0037591
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0037591
License Number StateNY

VIII. Authorized Official

Name: DR. MARK LENTINI
Title or Position: DOCTOR
Credential: D.P.M.
Phone: 518-456-2014