Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 180587 | NY |
N | 207VX0000X | Obstetrician | 180587 | NY |
NPI | 1043218951 |
---|---|
Provider Name | Martha Lynn Pisaniello |
First Address | Lowville, NY 13367-1297 |
Second Address | Lowville, NY 13367-1297 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 10/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01175575 | (05) | NY |
53628B | (02) | NY |
54933B | MEDICARE PTAN/PIN (01) | NY |