Healthcare Provider Details

I. General information

NPI: 1710207485
Provider Name (Legal Business Name): JOSEPH C GIANFAGNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 WASHINGTON ST SUITE 107
WATERTOWN NY
13601
US

IV. Provider business mailing address

1571 WASHINGTON ST SUITE 107
WATERTOWN NY
13601
US

V. Phone/Fax

Practice location:
  • Phone: 315-782-7330
  • Fax: 315-782-5773
Mailing address:
  • Phone: 315-782-7330
  • Fax: 315-782-5773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number268563
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number268563
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: