1477553253 NPI number — CATHERINE CORINA VIOLET GERONTIS M.D.

Table of content: CATHERINE CORINA VIOLET GERONTIS M.D. (NPI 1477553253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477553253 NPI number — CATHERINE CORINA VIOLET GERONTIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERONTIS
Provider First Name:
CATHERINE
Provider Middle Name:
CORINA VIOLET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GERONTIS
Provider Other First Name:
C
Provider Other Middle Name:
CORINA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1477553253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 595
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMMACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11725-0595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-439-0946
Provider Business Mailing Address Fax Number:
631-439-5447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58 VANDERBILT MOTOR PKWY STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMMACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11725-5724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-439-5440
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  188154 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207WX0110X , with the licence number: 188154 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 48Z811 . This is a "BLUE CROSS/CHILD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113547507 . This is a "EMPIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113547507 . This is a "GREAT WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 188154A27 . This is a "HEALTHFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2C8244 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112658697 . This is a "JJ NEW/USI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113547507 . This is a "CIGNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113547507 . This is a "ISLAND GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2436110 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31160P . This is a "HIP HEALTH CARE PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113547507 . This is a "BEECH TREE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8209571002 . This is a "CIGNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 188154A27 . This is a "HEALTHFIRST CHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0401751 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112658697 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27626 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: GC8154 . This is a "ATLANTIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31160P . This is a "HIP" identifier . This identifiers is of the category "OTHER".




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