Healthcare Provider Details

I. General information

NPI: 1144243460
Provider Name (Legal Business Name): PAUL PISARSKI RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 LINCOLN ST
WORCESTER MA
01605-1901
US

IV. Provider business mailing address

605 LINCOLN ST
WORCESTER MA
01605-1901
US

V. Phone/Fax

Practice location:
  • Phone: 508-856-0104
  • Fax: 508-853-4961
Mailing address:
  • Phone: 508-856-0104
  • Fax: 508-853-4961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number158084
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: