Individual
DANIEL P. PISANIELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3926 STATE ROUTE 12, LYONS FALLS, NY 13368-1919
(315) 348-8407
Mailing address
PO BOX 247, LYONS FALLS, NY 13368-0247
(315) 701-5610
(315) 701-5608
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
176752
NY
207QA0401X
Addiction Medicine (Family Medicine) Physician
176752
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01161302
—
NY
Enumeration date
06/16/2005
Last updated
05/01/2014
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