Healthcare Provider Details

I. General information

NPI: 1518858679
Provider Name (Legal Business Name): REBECCA LAUREN PIEKARSKI DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6144 ROUTE 25A
WADING RIVER NY
11792-2018
US

IV. Provider business mailing address

6144 ROUTE 25A
WADING RIVER NY
11792-2018
US

V. Phone/Fax

Practice location:
  • Phone: 631-880-6200
  • Fax:
Mailing address:
  • Phone: 631-880-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number357342
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number796852
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: