Provider Demographics
NPI:1124586201
Name:GENTILE, NICHOLAS JOHN
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOHN
Last Name:GENTILE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:GRADYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19039-0266
Mailing Address - Country:US
Mailing Address - Phone:610-558-4890
Mailing Address - Fax:
Practice Address - Street 1:1511 HEATHER HILLS LANE
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19039-0266
Practice Address - Country:US
Practice Address - Phone:610-558-4890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer