Provider Demographics
NPI:1750462156
Name:GATENIO, YAEL E (OD)
Entity Type:Individual
Prefix:
First Name:YAEL
Middle Name:E
Last Name:GATENIO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 SUNRISE MALL
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758
Mailing Address - Country:US
Mailing Address - Phone:516-795-2112
Mailing Address - Fax:516-795-2167
Practice Address - Street 1:2210 SUNRISE MALL
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-795-2112
Practice Address - Fax:516-795-2167
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005949-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTUV005949-1OtherOPTOMETRY