Provider Demographics
NPI:1811469703
Name:PIASECKI, THERESE D (NP)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:D
Last Name:PIASECKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WINDY HILL RD
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1731
Mailing Address - Country:US
Mailing Address - Phone:732-742-0097
Mailing Address - Fax:
Practice Address - Street 1:20 WINDY HILL RD
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-1731
Practice Address - Country:US
Practice Address - Phone:732-742-0097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00877300363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology