Individual
MR. CHARLES MICHAEL ANDOLA III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., P.A.
Contact information
Practice address
350 S MAIN ST, NEW CITY, NY 10956-3049
(845) 634-7500
(845) 634-7566
Mailing address
507 AIRPORT EXECUTIVE PARK, NANUET, NY 10954-5238
(845) 262-5313
(845) 426-6126
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002281
CT
363A00000X
Physician Assistant
Primary
013344-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A400123228
MEDICARE
NY
Enumeration date
06/29/2009
Last updated
03/22/2016
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