Provider Demographics
NPI:1356400386
Name:PIEKARSKI, ALEXANDER M (PHD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:M
Last Name:PIEKARSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940-0101
Mailing Address - Country:US
Mailing Address - Phone:631-878-1530
Mailing Address - Fax:631-878-5775
Practice Address - Street 1:587 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940-1234
Practice Address - Country:US
Practice Address - Phone:631-878-1530
Practice Address - Fax:631-878-5775
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011826-1103TC0700X
FLPY 7876103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01624919Medicaid
NY01624919Medicaid