Individual
DR. EDWARD J BIENIEWICZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
167 E MAIN ST, EAST ISLIP, NY 11730-2602
(631) 666-1700
(631) 666-1735
Mailing address
167 E MAIN ST, EAST ISLIP, NY 11730-2602
(631) 666-1700
(631) 666-1735
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
136080
NY
208600000X
Surgery Physician
136080
NY
208D00000X
General Practice Physician
Primary
136080
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0041653
AETNA PROVIDER NUMBER
NY
01
—
1000016145
AFFINITY PROVIDER NUMBER
NY
01
—
136080
LICENSE NUMBER
NY
01
—
136080-9
WORKERS COMP BOARD AUTH #
NY
01
—
26504P
HIP PRIS NUMBER
NY
01
—
7502
VYTRA PROVIDER NUMBER
NY
01
—
CS126
OXFORD PROVIDER NUMBER
NY
Enumeration date
01/03/2007
Last updated
03/07/2023
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