Provider Demographics
NPI:1912253238
Name:BIENIEK, MELISSA (MS)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:BIENIEK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 GLOUCESTER ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1667
Mailing Address - Country:US
Mailing Address - Phone:518-852-5771
Mailing Address - Fax:
Practice Address - Street 1:78 GLOUCESTER ST
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1667
Practice Address - Country:US
Practice Address - Phone:518-852-5771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist