Provider Demographics
NPI:1730297474
Name:PIASECKA, JADWIGA M
Entity type:Individual
Prefix:DR
First Name:JADWIGA
Middle Name:M
Last Name:PIASECKA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JADWIGA
Other - Middle Name:M
Other - Last Name:K-PIASECKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:811 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6715
Mailing Address - Country:US
Mailing Address - Phone:239-263-7425
Mailing Address - Fax:
Practice Address - Street 1:811 7TH AVE S
Practice Address - Street 2:SENIOR FRIENDSHIP CENTER.
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6715
Practice Address - Country:US
Practice Address - Phone:239-263-7425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLL575174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL767ZMedicare Oscar/Certification