Healthcare Provider Details

I. General information

NPI: 1063174043
Provider Name (Legal Business Name): ALISSA GIAMMARINO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/07/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 HARRISON ST
JOHNSON CITY NY
13790-2120
US

IV. Provider business mailing address

33 LEWIS RD 2ND FL
BINGHAMTON NY
13905
US

V. Phone/Fax

Practice location:
  • Phone: 607-729-4942
  • Fax: 607-729-7516
Mailing address:
  • Phone: 607-770-0025
  • Fax: 607-729-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348220
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: