Provider Demographics
NPI:1821102732
Name:GENTILE, DAVID A (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:GENTILE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8562
Mailing Address - Country:US
Mailing Address - Phone:631-821-4200
Mailing Address - Fax:631-821-6226
Practice Address - Street 1:797 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8562
Practice Address - Country:US
Practice Address - Phone:631-821-4200
Practice Address - Fax:631-821-6226
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219158204D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY927401Medicare PIN
NYH28986Medicare UPIN