Healthcare Provider Details

I. General information

NPI: 1669307658
Provider Name (Legal Business Name): ALEXANDER PISANELLO PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13109 ROCKAWAY ST
MALTA NY
12020-5230
US

IV. Provider business mailing address

13109 ROCKAWAY ST
MALTA NY
12020-5230
US

V. Phone/Fax

Practice location:
  • Phone: 518-764-5022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ALEXANDER PISANELLO
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 518-764-5022