Provider Demographics
NPI:1205972031
Name:PISANELLI SURGICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:PISANELLI SURGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:J
Authorized Official - Last Name:PISANELLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:802-773-2900
Mailing Address - Street 1:69 ALLEN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4564
Mailing Address - Country:US
Mailing Address - Phone:802-773-2900
Mailing Address - Fax:802-775-3377
Practice Address - Street 1:69 ALLEN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4564
Practice Address - Country:US
Practice Address - Phone:802-773-2900
Practice Address - Fax:802-775-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002375Medicaid
VTVT2375Medicare ID - Type Unspecified
VTC65222Medicare UPIN