Provider Demographics
NPI:1609615749
Name:CEGIELSKI HEALTH LLC
Entity type:Organization
Organization Name:CEGIELSKI HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CEGIELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-344-2197
Mailing Address - Street 1:4510 W GUADALUPE ST APT 123
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3083
Mailing Address - Country:US
Mailing Address - Phone:409-344-2197
Mailing Address - Fax:
Practice Address - Street 1:4510 W GUADALUPE ST APT 123
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-3083
Practice Address - Country:US
Practice Address - Phone:409-344-2197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center