Healthcare Provider Details

I. General information

NPI: 1821102732
Provider Name (Legal Business Name): DAVID A GENTILE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

797 ROUTE 25A
ROCKY POINT NY
11778-8562
US

IV. Provider business mailing address

797 ROUTE 25A
ROCKY POINT NY
11778-8562
US

V. Phone/Fax

Practice location:
  • Phone: 631-821-4200
  • Fax: 631-821-6226
Mailing address:
  • Phone: 631-821-4200
  • Fax: 631-821-6226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number219158
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: