Provider Demographics
NPI:1528074259
Name:GATTONE, JENNIFER LEIGH (BO-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:GATTONE
Suffix:
Gender:F
Credentials:BO-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEIGH
Other - Last Name:ESTLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BO-C
Mailing Address - Street 1:925 CHESTNUT ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4216
Mailing Address - Country:US
Mailing Address - Phone:267-339-3500
Mailing Address - Fax:215-503-0580
Practice Address - Street 1:443 LAUREL OAK RD
Practice Address - Street 2:SUITE 130
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4451
Practice Address - Country:US
Practice Address - Phone:856-821-6360
Practice Address - Fax:856-821-6359
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45OR00004200222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist