Provider Demographics
NPI:1891791489
Name:BIENIEK, MARZENA L (MD)
Entity Type:Individual
Prefix:
First Name:MARZENA
Middle Name:L
Last Name:BIENIEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 5TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-6523
Mailing Address - Country:US
Mailing Address - Phone:610-432-8185
Mailing Address - Fax:610-432-8187
Practice Address - Street 1:352 5TH ST
Practice Address - Street 2:STE B
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-6523
Practice Address - Country:US
Practice Address - Phone:610-432-8185
Practice Address - Fax:610-432-8187
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052561L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF77311Medicare UPIN
PA763403Medicare ID - Type UnspecifiedMEDICARE PROVIDER #