Provider Demographics
NPI:1457424533
Name:MARZENA BIENIEK, MD, PC
Entity Type:Organization
Organization Name:MARZENA BIENIEK, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARZENA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIENIEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-432-8185
Mailing Address - Street 1:352 5TH ST
Mailing Address - Street 2:SUITE 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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052561L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01460506Medicaid
PA080028Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PA01460506Medicaid