1417924093 NPI number — DANIEL W. BIENKOWSKI M.D., P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417924093 NPI number — DANIEL W. BIENKOWSKI M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL W. BIENKOWSKI M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417924093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 WOODLAND RD
Provider Second Line Business Mailing Address:
SUITE 318
Provider Business Mailing Address City Name:
STONEHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02180-1702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-665-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 WOODLAND RD
Provider Second Line Business Practice Location Address:
SUITE 318
Provider Business Practice Location Address City Name:
STONEHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02180-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-665-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BIENKOWSKI
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
781-665-5000

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  39450 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B10029 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0093639 . This is a "US HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2420173001 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 17154 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 26152 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0021264 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 993002 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 702670 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9775544 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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