Provider Demographics
NPI:1477553253
Name:GERONTIS, CATHERINE CORINA VIOLET (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:CORINA VIOLET
Last Name:GERONTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:C
Other - Middle Name:CORINA
Other - Last Name:GERONTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 595
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-0595
Mailing Address - Country:US
Mailing Address - Phone:631-439-0946
Mailing Address - Fax:631-439-5447
Practice Address - Street 1:58 VANDERBILT MOTOR PKWY STE 300
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5724
Practice Address - Country:US
Practice Address - Phone:631-439-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188154207W00000X, 207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
48Z811OtherBLUE CROSS/CHILD
113547507OtherEMPIRE
113547507OtherGREAT WEST
188154A27OtherHEALTHFIRST
2C8244OtherHEALTH NET
112658697OtherJJ NEW/USI
113547507OtherCIGNA PPO
113547507OtherISLAND GROUP
2436110OtherAETNA
31160POtherHIP HEALTH CARE PARTNERS
113547507OtherBEECH TREE
8209571002OtherCIGNA HMO
188154A27OtherHEALTHFIRST CHP
0401751OtherGHI
112658697OtherFIRST HEALTH
27626OtherANTHEM
GC8154OtherATLANTIS
31160POtherHIP
188154A27OtherHEALTHFIRST
188154A27OtherHEALTHFIRST CHP