Healthcare Provider Details

I. General information

NPI: 1801128608
Provider Name (Legal Business Name): MAREK PILECKI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 04/16/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 WASHINGTON ST
NORWICH CT
06360-2740
US

IV. Provider business mailing address

99 EAST RIVER DRIVE 5TH FLOOR
EAST HARTFORD CT
06108-7301
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-8331
  • Fax:
Mailing address:
  • Phone: 860-282-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4297
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: