Provider Demographics
NPI:1992791479
Name:GIANNONE, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GIANNONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:607-467-6219
Practice Address - Street 1:53 PINE ST
Practice Address - Street 2:DEPOSIT FAMILY CARE CENTER
Practice Address - City:DEPOSIT
Practice Address - State:NY
Practice Address - Zip Code:13754-1301
Practice Address - Country:US
Practice Address - Phone:607-467-4195
Practice Address - Fax:607-467-6219
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1618701207Q00000X
NY161870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009395960Medicaid
NY009395960Medicaid
NYH70192Medicare PIN
B82809Medicare UPIN