Timothy Robert Gandolfo, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

330997 Issued in NY

Practice address

79 Middleville Rd
Northport, NY 11768-2200

Phone

(631) 261-4400

NPI assigned

Apr 14, 2021

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

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tgandolfo196520@direct-guthrie.org

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.

• Advantage Care Diagnostic and Treatment Center ,Inc

  • Federally Qualified Health Center (FQHC)
  • Brookville, NY
  • NPI 1073689600
  Medicare reassignment NPD

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

{
    "created_epoch": "1618358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787702400000",
    "number": "1891375671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 MIDDLEVILLE RD",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117682200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 MIDDLEVILLE RD",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117682200",
            "telephone_number": "631-261-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANDOLFO",
        "first_name": "TIMOTHY",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-14",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "330997",
            "primary": true
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "NY",
            "license": "330997",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deirdra F Frum, PSY.D
• Benjamin Fung, D.D.S.
• Eric Fung
• Dylan Paul Galasso, LMSW
• Aileen M Gallagher, PT
• Christian Paul Garces, LMSW
• Carol A Garklavs, MSW, LCSW
• Jaclyn Gartner
• Michelle Ann Garvey, OTR/L
• David Wayne Gately, PHD

• Family Medicine Physician in Northport, NY
• Providers in Northport, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; 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.