Provider Demographics
NPI:1235118134
Name:GENTILE, CHRISTOPHER (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:GENTILE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3826
Mailing Address - Country:US
Mailing Address - Phone:516-379-4041
Mailing Address - Fax:516-771-6794
Practice Address - Street 1:21 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3826
Practice Address - Country:US
Practice Address - Phone:516-379-4041
Practice Address - Fax:516-771-6794
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT004665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00990794Medicaid
NY410005767Medicare PIN
NYC32171Medicare PIN
NY00990794Medicaid
NYC32173Medicare PIN
NYC32172Medicare PIN
NYT65129Medicare UPIN