Provider Demographics
NPI:1447310743
Name:GAIL E. CORREALE, O.D., PLLC
Entity type:Organization
Organization Name:GAIL E. CORREALE, O.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORREALE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-873-0742
Mailing Address - Street 1:88 JENKINS ST
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1714
Mailing Address - Country:US
Mailing Address - Phone:516-223-1902
Mailing Address - Fax:
Practice Address - Street 1:630 OLD COUNTRY RD
Practice Address - Street 2:ROOSEVELT FIELD MALL
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3467
Practice Address - Country:US
Practice Address - Phone:516-873-0742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006373152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNY6373Medicare UPIN