Carlo Ivan Gwardschaladse, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

005375 Issued in NY

Practice address

19 Bradhurst Ave
Hawthorne, NY 10532-2139

Phone

(914) 345-0162

Fax

(914) 347-4401

NPI assigned

Sep 15, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209945600000",
    "number": "1386639441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 GRASSLANDS RD",
            "address_2": "MUNGER PAVILION",
            "city": "VALHALLA",
            "state": "NY",
            "postal_code": "105951652",
            "telephone_number": "914-493-7621",
            "fax_number": "914-594-4359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 BRADHURST AVE",
            "city": "HAWTHORNE",
            "state": "NY",
            "postal_code": "105322139",
            "telephone_number": "914-345-0162",
            "fax_number": "914-347-4401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWARDSCHALADSE",
        "first_name": "CARLO",
        "middle_name": "IVAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-15",
        "last_updated": "2008-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "005375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dov Grosser
• Eric Joseph Grossman I, LCSW
• Olivia Grubman, M.D., M.P.H
• Lauren Gurciullo, SPECIAL EDUCATOR
• Farrah Elyse Gutwein, D.O.
• Anissa Hairston, R.N.
• Ashleigh Anna Halderman, MD
• Pamela R Halpern, PA
• Victoria Hamilton, PA-C
• Madhura Nikhil Hanmantgad, MD

• Physician Assistant in Hawthorne, NY
• Providers in Hawthorne, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.