Individual
MARTHA LYNN PISANIELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7785 N STATE ST FL 3, LOWVILLE, NY 13367-1297
(315) 376-5287
(315) 376-3228
Mailing address
7785 N STATE ST FL 3, LOWVILLE, NY 13367-1297
(315) 376-5287
(315) 376-3228
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
180587
NY
207VX0000X
Obstetrics Physician
180587
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01175575
—
NY
01
—
54933B
MEDICARE PTAN/PIN
NY
Enumeration date
07/13/2005
Last updated
06/10/2021
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