1700848355 NPI number — JUSTIN H PIASECKI M.D.

Table of content: JUSTIN H PIASECKI M.D. (NPI 1700848355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700848355 NPI number — JUSTIN H PIASECKI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIASECKI
Provider First Name:
JUSTIN
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700848355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9515 64TH ST NW STE 310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIG HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98335-5631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-509-4438
Provider Business Mailing Address Fax Number:
888-843-2412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11511 CANTERWOOD BLVD STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIG HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98332-5820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-858-5040
Provider Business Practice Location Address Fax Number:
888-843-2412
Provider Enumeration Date:
04/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  MD00049097 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ND0101X , with the licence number: MD00049097 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)