Provider Demographics
NPI:1477780922
Name:JUSTIN H. PIASECKI, M.D., PLLC
Entity Type:Organization
Organization Name:JUSTIN H. PIASECKI, M.D., PLLC
Other - Org Name:HARBOR PLASTIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:PIASECKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-509-4438
Mailing Address - Street 1:4804 OLD STUMP DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8899
Mailing Address - Country:US
Mailing Address - Phone:253-509-4438
Mailing Address - Fax:
Practice Address - Street 1:11511 CANTERWOOD BLVD NW
Practice Address - Street 2:SUITE 310
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-5813
Practice Address - Country:US
Practice Address - Phone:253-509-4438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00049097261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology