1205362308 NPI number — RONALD CONCETTO GENTILE MD, PC

Table of content: (NPI 1205362308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205362308 NPI number — RONALD CONCETTO GENTILE MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONALD CONCETTO GENTILE MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205362308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 SEA CREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LLOYD HARBOR
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11743-9765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-979-4120
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
218 SECOND AVENUE
Provider Second Line Business Practice Location Address:
SUITE 402 SOUTH
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-979-4120
Provider Business Practice Location Address Fax Number:
646-290-8008
Provider Enumeration Date:
05/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
GENTILE
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
CONCETTO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
212-979-4120

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X , with the licence number:  189544 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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