Healthcare Provider Details

I. General information

NPI: 1356400386
Provider Name (Legal Business Name): ALEXANDER M PIEKARSKI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 MONTAUK HWY
EAST MORICHES NY
11940-1234
US

IV. Provider business mailing address

PO BOX 101
EAST MORICHES NY
11940-0101
US

V. Phone/Fax

Practice location:
  • Phone: 631-878-1530
  • Fax: 631-878-5775
Mailing address:
  • Phone: 631-878-1530
  • Fax: 631-878-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number011826-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 7876
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: