Lisa Gandolfo, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

185190-1 Issued in NY

Practice address

630 W 168TH St # MC28
New York, NY 10032-3725

Phone

(212) 305-1948

Fax

(212) 305-5777

NPI assigned

Jun 17, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Trustees of Columbia University in the City of New York

  • Nuclear Radiology Physician
  • New York, NY
  • NPI 1730297011
  NPD
• Trustees of Columbia University in the City of New York

  • Diagnostic Radiology Physician
  • New York, NY
  • NPI 1043328354
  NPD (past)
• Medical Imaging of Teaneck Inc.

  • Mobile Radiology Clinic/Center
  • Teaneck, NJ
  • NPI 1164466926
  NPD (past)
• Teaneck Radiology Center LLC

  • Radiology Clinic/Center
  • Teaneck, NJ
  • NPI 1851445027
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196121600000",
    "number": "1194760108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 W 168TH ST # MC28",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323725",
            "telephone_number": "212-305-1948",
            "fax_number": "212-305-5777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 W 168TH ST # MC28",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323725",
            "telephone_number": "212-305-1948",
            "fax_number": "212-305-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANDOLFO",
        "first_name": "LISA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-17",
        "last_updated": "2007-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "185190-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "W35021",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01424666",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP #",
            "identifier": "02186203",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachelle Grace Gandica, M.D.
• Neetha Gandikota, MD
• Anaba NMN Gandini, LP
• David Gandler, M.D.
• Brad Michael Gandolfi, M.D.
• Samuel E. Gandy, M.D.
• Jaya B Ganesh, M.D.
• Maya Ganeshan
• Bonnie Greer Gang, LCSW
• Karen Gang

• Diagnostic Radiology Physician in New York, NY
• Providers in New York, NY by specialty
• Diagnostic Radiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.