Provider Demographics
NPI:1396821914
Name:M LYNN PISANIELLO, MD
Entity Type:Organization
Organization Name:M LYNN PISANIELLO, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PISANIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-376-5200
Mailing Address - Street 1:PO BOX 9450
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-0450
Mailing Address - Country:US
Mailing Address - Phone:315-376-5200
Mailing Address - Fax:
Practice Address - Street 1:7785 N STATE ST
Practice Address - Street 2:LEWIS COUNTY GENERAL HOSPITAL
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1229
Practice Address - Country:US
Practice Address - Phone:315-376-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53628BMedicare ID - Type UnspecifiedNYS MEDICARE GROUP #