Individual provider Active NPI

Charlie Louie Gagliardo, PA

  • Physician Assistant
  • Astoria, NY
National Provider Identifier
1487086419
Registry record updated Jul 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
016762 Issued in NY
Practice address
2510 30TH Ave
Astoria, NY 11102-2418
Phone
(718) 932-1000
NPI assigned
Aug 1, 2013
Last updated
Jul 17, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 016762 NY Primary

Addresses

Primary practice location

2510 30TH Ave
Astoria, NY 11102-2418

Mailing address

2510 30TH Ave
Astoria, NY 11102-2418
Phone (718) 932-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131002000317 NY Practitioner - Physician Assistant 0547494700 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2510 30TH Ave
Astoria, NY 11102-2448
Phone (718) 932-1000

2520 30TH Ave
Astoria, NY 11102-2448
Phone (718) 808-7777

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
016762NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Aug 1, 2023 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Aug 1, 2023 Accepting new patients

Locations

374 Stockholm St
#137N
Brooklyn, NY 11237
Phone (718) 963-6485

2510 30th Ave
Long Island City, NY 11102
Phone (718) 267-4245

150 E 42nd St
Fl 2E678
New York, NY 10017

10114 Liberty Ave
#13292
Ozone Park, NY 11417
Phone (718) 487-3330

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 2

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

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1375315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1487086419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 30TH AVE",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111022418",
            "telephone_number": "718-932-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 30TH AVE",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111022418",
            "telephone_number": "718-932-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAGLIARDO",
        "first_name": "CHARLIE",
        "middle_name": "LOUIE",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-01",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "016762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Astoria, NY

Sources for this page

Verify at the official NPI Registry.