Charles Timothy Fasanya, M.D
Individual provider Active NPI Surgical Critical Care Physician · Middletown, NY
NPI 1710149356 · NPPES record last updated Apr 2, 2018
Key facts
- NPI
- 1710149356
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Critical Care Physician 2086S0102X
- License
- 254698 (NY)
- Practice address
- 707 E Main St
Middletown, NY 10940-2650 - Phone
- (845) 333-7575
- Fax
- (845) 333-1454
- NPI assigned
- Jun 25, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- General Surgery
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Samaritan Emergency Medical Services PC
CHS Physician Partners PC
Practice addresses (Care Compare)
1000 Montauk Hwy
West Islip, NY 11795-4927
Phone (631) 376-4094
24 E Main St
Bay Shore, NY 11706-8363
Phone (631) 666-6752
Hospital & facility affiliations
- Good Samaritan Hospital Medical Center
- Chsli St Joseph Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Upper gastrointestinal (GI) endoscopy for acid reflux | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in NJ, NY, VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090210000723 | NJ | Practitioner - Critical Care (Intensivists) |
8729143698 | Reassigns benefits to 1 organization |
| I20091022000182 | NY | Practitioner - General Surgery |
8729143698 | Reassigns benefits to 3 organizations |
| I20200416002307 | VA | Practitioner - General Surgery |
8729143698 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 254698 | NY | MD | Licensed Practical Nurse |
Practice roles (11 of 15)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CHS Physician Partners, PC | Current | Accepting new patients | |
| Westchester Medical Center Advanced Physician Services, PC | Surgery | Current |
Accepting new patients |
| Hunterdon Specialty Care, PC | Surgery | Current |
Accepting new patients |
| Hunterdon Specialty Care | Current |
Accepting new patients | |
| CHS Physician Partners, P.C | Current |
Accepting new patients | |
| CHS Physician Partners, PC | Current |
Accepting new patients | |
| Westchester Medical Center Advanced Physician Services PC | Current |
Accepting new patients | |
| Samaritan Emergency Medical Services, PC | Current |
Accepting new patients | |
| Hunterdon Specialty Care PC | Current | Accepting new patients | |
| Good Samaritan Hospital Medical Center | Past | Accepting new patients | |
| Premier Trauma and Surgical Specialists LLC | Past |
Accepting new patients |
Locations
1251 US Highway 22
Bridgewater, NJ 08807
Phone (908) 237-4108
215 State Route 31
#116
Flemington, NJ 08822
6 Sand Hill Rd
Ste 202
Flemington, NJ 08822
Phone (908) 237-4080
24 E Main St
Bay Shore, NY 11706
Phone (613) 666-6752
45 Park Ave
Bay Shore, NY 11706
Phone (631) 376-0700
19 Bradhurst Ave
Ste 3100N
Hawthorne, NY 10532
Phone (914) 231-8373
707 E Main St
Middletown, NY 10940
Phone (845) 333-1000
241 North Rd
Poughkeepsie, NY 12601
Phone (845) 431-8889
1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012
100 Port Washington Blvd
Ste G3
Roslyn, NY 11576
Phone (516) 627-4800
95 Grasslands Rd
Valhalla, NY 10595
Phone (914) 493-2961
1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
Interoperability endpoints
- charlesfasanya@nslijmedgr.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 25MA08347800 | NJ | |
| Surgical Critical Care Physician | 2086S0102X | 254698 | NY | Yes |
Addresses
Primary practice location
707 E Main St
Middletown, NY 10940-2650
Mailing address
707 E Main St
Middletown, NY 10940-2650
Phone (845) 333-1114
Other practice location 1
256 Mason Ave
Bldg B, 2nd Floor
Staten Island, NY 10305-3408
Phone (718) 226-6260
Other practice location 2
256 Mason Ave
Bldg B, 2nd Floor
Staten Island, NY 10305-3408
Phone (718) 226-6260
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 254698 | Other | NY | NEW YORK STATE LICENSE |
| 25MA08347800 | Other | NJ | MEDICAL LICENSE |
| 0181781 | Medicaid | NJ |
Other providers in Middletown, NY
- Tyler Farnell
- Faiza Farooq
- Umar Farooq
- Muhammad Anas Farooqi
- Albert N Farron
- Andrew Jay Faskowitz
- Naila Fatima
- Ernst Fattakhov
- Colleen Faust
- Samantha Favara
All providers in Middletown, NY · Surgical Critical Care Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.