Provider Demographics
NPI:1174574651
Name:LENTINE, GWENN (MD)
Entity type:Individual
Prefix:
First Name:GWENN
Middle Name:
Last Name:LENTINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1855 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3909
Mailing Address - Country:US
Mailing Address - Phone:347-745-2828
Mailing Address - Fax:718-761-7226
Practice Address - Street 1:1855 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3909
Practice Address - Country:US
Practice Address - Phone:347-745-2828
Practice Address - Fax:718-761-7226
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY177639207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY68F931Medicare UPIN