Provider Demographics
NPI:1861667156
Name:DAVID A. GENTILE, DO CACPC
Entity Type:Organization
Organization Name:DAVID A. GENTILE, DO CACPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELYSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FALZONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-821-4200
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 1:160 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-3413
Practice Address - Country:US
Practice Address - Phone:631-821-4200
Practice Address - Fax:631-821-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219158208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY927401Medicare PIN
NYH28986Medicare UPIN