Provider Demographics
NPI:1396955696
Name:GENTNER, SUZANNE (CNM)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:GENTNER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 LEFFERTS AVE
Mailing Address - Street 2:FAMILY HEALTH SERVICES
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1301
Mailing Address - Country:US
Mailing Address - Phone:718-493-5584
Mailing Address - Fax:718-493-6166
Practice Address - Street 1:840 LEFFERTS AVE
Practice Address - Street 2:FAMILY HEALTH SERVICES
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1301
Practice Address - Country:US
Practice Address - Phone:718-493-5584
Practice Address - Fax:718-493-6166
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000040367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife