Charles Michael Andola III, M.S., P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

013344-1 Issued in NY

Practice address

350 S Main St
New City, NY 10956-3049

Phone

(845) 634-7500

Fax

(845) 634-7566

NPI assigned

Jun 29, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Physician Assistant

State licenses

Practice roles

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.

• Montefiore Medical Center

  • Anesthesiology Physician
  • Bronx, NY
  • NPI 1063525152
  NPD (past)

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458604800000",
    "number": "1659509628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 AIRPORT EXECUTIVE PARK",
            "city": "NANUET",
            "state": "NY",
            "postal_code": "109545238",
            "telephone_number": "845-262-5313",
            "fax_number": "845-426-6126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 S MAIN ST",
            "city": "NEW CITY",
            "state": "NY",
            "postal_code": "109563049",
            "telephone_number": "845-634-7500",
            "fax_number": "845-634-7566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDOLA",
        "first_name": "CHARLES",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "M.S., P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-29",
        "last_updated": "2016-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "002281",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "013344-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "A400123228",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shaya Alpert
• Robert Alvir, PT
• Oksana Alyekseyenko-Petrie, LPN
• Sara Ameri
• Anc Medical LLC
• Hermine Andres
• Andrew Tang OD PLLC
• Jeanne Andrews, LCSW-R
• Manju Andrews
• Vanessa Angelet-Torres

• Physician Assistant in New City, NY
• Providers in New City, 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 Mar 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.