Provider Demographics
NPI:1871770149
Name:GIANCOLA THERAPEUTICS
Entity type:Organization
Organization Name:GIANCOLA THERAPEUTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:GIANCOLA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:716-531-4391
Mailing Address - Street 1:8672 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7502
Mailing Address - Country:US
Mailing Address - Phone:716-531-4391
Mailing Address - Fax:
Practice Address - Street 1:8672 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7502
Practice Address - Country:US
Practice Address - Phone:716-531-4391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2803-1335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1053332577Medicare NSC