Provider Demographics
NPI:1225479975
Name:GIANNELLI, FRANK R III (PA)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:R
Last Name:GIANNELLI
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 LONGFELLOW AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-4333
Mailing Address - Country:US
Mailing Address - Phone:089-578-9414
Mailing Address - Fax:
Practice Address - Street 1:1314 PARK AVE STE 3
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3253
Practice Address - Country:US
Practice Address - Phone:732-235-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016612363A00000X
NJ25MP00400400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03630224Medicaid
NY016612OtherLICENSE
NY03630224Medicaid