Provider Demographics
NPI:1417924093
Name:DANIEL W. BIENKOWSKI M.D., P.C.
Entity Type:Organization
Organization Name:DANIEL W. BIENKOWSKI M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BIENKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-665-5000
Mailing Address - Street 1:3 WOODLAND RD
Mailing Address - Street 2:SUITE 318
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1702
Mailing Address - Country:US
Mailing Address - Phone:781-665-5000
Mailing Address - Fax:
Practice Address - Street 1:3 WOODLAND RD
Practice Address - Street 2:SUITE 318
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1702
Practice Address - Country:US
Practice Address - Phone:781-665-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39450207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB10029OtherBLUE CROSS/BLUE SHIELD
MA0093639OtherUS HEALTHCARE
MA2420173001OtherCIGNA
MA17154OtherHARVARD PILGRIM
MA26152OtherFALLON
MA0021264OtherNEIGHBORHOOD HEALTH PLAN
MA993002OtherNETWORK HEALTH
MA702670OtherTUFTS HEALTH PLAN
MA9775544Medicaid
MA0021264OtherNEIGHBORHOOD HEALTH PLAN
MA2420173001OtherCIGNA