Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 34965 | FL |
Y | 213ES0000X | Sports Medicine | 34965 | FL |
NPI | 1043855091 |
---|---|
Provider Name | Max Piasecki |
First Address | New York, NY 10087-2076 |
Second Address | West Palm Beach, FL 33401-2710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2019 |
Last Update Date | 27/01/2022 |