MEDICARE: RACHEL GENTILE MA, CCC, SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	41YS00877300	NJ

General Provider Information

NPI Number	:	1720526932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL GENTILE MA, CCC, SLP

Provider Business Mailing Address
First Line	:	22 TROY DR APT B
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-2019
Country	:	US
Telephone Number	:	908-447-6044
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 TROY DR APT B
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-2019
Country	:	US
Telephone Number	:	908-447-6044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2017
Last Update Date	:	02/08/2017

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