Provider Demographics
NPI:1104451848
Name:GIANNA OF SYRACUSE MEDICAL PLLC
Entity type:Organization
Organization Name:GIANNA OF SYRACUSE MEDICAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-640-5576
Mailing Address - Street 1:1141 EAST UNION ST.
Mailing Address - Street 2:#9201
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-1919
Mailing Address - Country:US
Mailing Address - Phone:585-310-8787
Mailing Address - Fax:
Practice Address - Street 1:1880 E RIDGE RD STE 8
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2450
Practice Address - Country:US
Practice Address - Phone:585-310-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05240455Medicaid