MEDICARE: DANIEL P. PISANIELLO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	176752	NY
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	176752	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710982616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL P. PISANIELLO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 247
Second Line	:
City	:	LYONS FALLS
State	:	NY
Zip	:	13368-0247
Country	:	US
Telephone Number	:	315-701-5610
Fax Number	:	315-701-5608

Provider Business Practice Location Address
First Line	:	3926 STATE ROUTE 12
Second Line	:
City	:	LYONS FALLS
State	:	NY
Zip	:	13368-1919
Country	:	US
Telephone Number	:	315-348-8407
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	05/01/2014

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