Healthcare Provider Details

I. General information

NPI: 1225479975
Provider Name (Legal Business Name): FRANK R GIANNELLI III PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 PARK AVE STE 3
PLAINFIELD NJ
07060-3253
US

IV. Provider business mailing address

447 LONGFELLOW AVE
WESTFIELD NJ
07090-4333
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-4445
  • Fax:
Mailing address:
  • Phone: 89-578-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number016612
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00400400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier03630224
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier016612
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: