MEDICARE: MIRANDA C GENTILE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1295504363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA C GENTILE

Provider Business Mailing Address
First Line	:	3324 LONG BEACH RD FL 1
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-5048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3324 LONG BEACH RD FL 1
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-5048
Country	:	US
Telephone Number	:	516-620-5809
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2023
Last Update Date	:	12/29/2023

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Directions to “ MIRANDA C GENTILE ” Practice Location

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