Individual
MRS. JESSICA M GENTILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
22 WYCOMB PL, CORAM, NY 11727-1045
(631) 473-3871
(631) 473-3871
Mailing address
22 WYCOMB PL, CORAM, NY 11727-1045
(631) 473-3871
(631) 473-3871
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1768097
NYS OF EDUCATION DEPARTME
NY
Enumeration date
12/11/2007
Last updated
12/11/2007
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