Provider Demographics
NPI:1528347374
Name:GEPPETTO MANAGEMENT CORP
Entity type:Organization
Organization Name:GEPPETTO MANAGEMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-631-8211
Mailing Address - Street 1:14 SCENICVIEW CRES
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2978
Mailing Address - Country:US
Mailing Address - Phone:631-830-3800
Mailing Address - Fax:
Practice Address - Street 1:3990 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3334
Practice Address - Country:US
Practice Address - Phone:631-474-3808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty