Healthcare Provider Details

I. General information

NPI: 1861355521
Provider Name (Legal Business Name): MR. MICHAEL R GIANNONE I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 WALL ST APT 104
CLIFTON PARK NY
12065-3886
US

IV. Provider business mailing address

PO BOX 2128
MALTA NY
12020-8128
US

V. Phone/Fax

Practice location:
  • Phone: 518-505-4650
  • Fax:
Mailing address:
  • Phone: 518-505-4650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: