Provider Demographics
NPI:1336675156
Name:RETINA INSTITUTE OF NEW YORK, LLP
Entity Type:Organization
Organization Name:RETINA INSTITUTE OF NEW YORK, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-979-4120
Mailing Address - Street 1:27 SEA CREST DR
Mailing Address - Street 2:
Mailing Address - City:LLOYD HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11743-9765
Mailing Address - Country:US
Mailing Address - Phone:212-979-4120
Mailing Address - Fax:
Practice Address - Street 1:218 SECOND AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4201
Practice Address - Country:US
Practice Address - Phone:212-979-4120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189544261QI0500X, 261QR1100X, 261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch