Individual
CARLO IVAN GWARDSCHALADSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
19 BRADHURST AVE, HAWTHORNE, NY 10532-2139
(914) 345-0162
(914) 347-4401
Mailing address
95 GRASSLANDS RD, MUNGER PAVILION, VALHALLA, NY 10595-1652
(914) 493-7621
(914) 594-4359
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005375
NY
Other
Enumeration date
09/15/2005
Last updated
05/05/2008
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