Provider Demographics
NPI:1184713638
Name:ENTE, GERALD (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:ENTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3733
Mailing Address - Country:US
Mailing Address - Phone:516-873-3683
Mailing Address - Fax:516-873-3684
Practice Address - Street 1:344 1ST ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3733
Practice Address - Country:US
Practice Address - Phone:516-873-3683
Practice Address - Fax:516-873-3684
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078228208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20760204OtherPHCS
NY2696188OtherGHI
NY000030152240OtherFIDELIS
NY078228OtherHIP
NY141951OtherEMPIRE BCBS
NY4094489OtherUS HEALTH PPO
NY000233940101OtherHEALTHPLUS
NY100015359OtherAFFINITY
NY11300OtherVYTRA
NY20041OtherUSHEALTH
NY3C4748OtherHEALTHNET/ACS
NY12981301OtherUNITED HEALTHCARE
NYAA50714AOtherMDNY
NY00108383Medicaid
NY0580321013OtherSIGNA
NY15949POtherHIP PRISS#
NY078228B27OtherHEALTHFIRST
NY6B2281OtherEMPIRE
NYAP107OtherOXFORD
NY00108383Medicaid