Provider Demographics
NPI:1124039854
Name:GENTILE, RONALD (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:GENTILE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:218 SECOND AVE
Mailing Address - Street 2:SUITE 402 SOUTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4201
Mailing Address - Country:US
Mailing Address - Phone:212-979-4120
Mailing Address - Fax:646-290-8008
Practice Address - Street 1:218 SECOND AVE
Practice Address - Street 2:SUITE 402 SOUTH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-979-4120
Practice Address - Fax:646-290-8008
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY189544207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01579280Medicaid
NY209351Medicare ID - Type Unspecified
NYG05644Medicare UPIN