Individual
JACQUELYN GENTILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1184 5TH AVE, NEW YORK, NY 10029-6503
(212) 241-9500
Mailing address
30 GERALD LN, OLD BETHPAGE, NY 11804-1112
(516) 454-0730
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
F383203
NY
Other
Enumeration date
04/09/2021
Last updated
04/09/2021
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