1. Home
  2. Directory
  3. New York
  4. East Islip
  5. General Practice
  6. NPI Profile
  7. NPI Record 1750448031

DR. EDWARD J BIENIEWICZ MD
Complete NPI Record 1750448031
General Practice in East Islip, NY

NPI Status: Active since January 03, 2007

Contact Information

167 E MAIN ST
EAST ISLIP, NY
ZIP 11730
Phone: (631) 666-1700
Fax: (631) 666-1735

Get Directions

Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Name Prefix Text
  7. Provider Credential Text
  8. Provider First Line Business Mailing Address
  9. Provider Business Mailing Address City Name
  10. Provider Business Mailing Address State Name
  11. Provider Business Mailing Address Postal Code
  12. Provider Business Mailing Address Country Code If outside U S
  13. Provider Business Mailing Address Telephone Number
  14. Provider Business Mailing Address Fax Number
  15. Provider First Line Business Practice Location Address
  16. Provider Business Practice Location Address City Name
  17. Provider Business Practice Location Address State Name
  18. Provider Business Practice Location Address Postal Code
  19. Provider Business Practice Location Address Country Code If outside U S
  20. Provider Business Practice Location Address Telephone Number
  21. Provider Business Practice Location Address Fax Number
  22. Provider Enumeration Date
  23. Last Update Date
  24. Provider Gender Code
  25. Healthcare Provider Taxonomy Code 1
  26. Provider License Number 1
  27. Provider License Number State Code 1
  28. Healthcare Provider Primary Taxonomy Switch 1
  29. Healthcare Provider Taxonomy Code 2
  30. Provider License Number 2
  31. Provider License Number State Code 2
  32. Healthcare Provider Primary Taxonomy Switch 2
  33. Healthcare Provider Taxonomy Code 3
  34. Provider License Number 3
  35. Provider License Number State Code 3
  36. Healthcare Provider Primary Taxonomy Switch 3
  37. Other Provider Identifier 1
  38. Other Provider Identifier Type Code 1
  39. Other Provider Identifier State 1
  40. Other Provider Identifier Issuer 1
  41. Other Provider Identifier 2
  42. Other Provider Identifier Type Code 2
  43. Other Provider Identifier State 2
  44. Other Provider Identifier Issuer 2
  45. Other Provider Identifier 3
  46. Other Provider Identifier Type Code 3
  47. Other Provider Identifier State 3
  48. Other Provider Identifier Issuer 3
  49. Other Provider Identifier 4
  50. Other Provider Identifier Type Code 4
  51. Other Provider Identifier State 4
  52. Other Provider Identifier Issuer 4
  53. Other Provider Identifier 5
  54. Other Provider Identifier Type Code 5
  55. Other Provider Identifier State 5
  56. Other Provider Identifier Issuer 5
  57. Other Provider Identifier 6
  58. Other Provider Identifier Type Code 6
  59. Other Provider Identifier State 6
  60. Other Provider Identifier Issuer 6
  61. Other Provider Identifier 7
  62. Other Provider Identifier Type Code 7
  63. Other Provider Identifier State 7
  64. Other Provider Identifier Issuer 7
  65. Is Sole Proprietor
  66. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1750448031. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1750448031
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Entity Type Code: 1
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Provider First Name: EDWARD
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Provider Middle Name: J
The middle name of the provider, if the provider is an individual.
Provider Name Prefix Text: DR.
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider Credential Text: MD
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: 167 E MAIN ST
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: EAST ISLIP
The telephone number associated with the location address of the provider being identified.
Provider Business Mailing Address State Name: NY
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 117302602
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 6316661700
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 6316661735
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 167 E MAIN ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: EAST ISLIP
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: NY
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider Business Practice Location Address Postal Code: 117302602
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 6316661700
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 6316661735
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 1/3/2007
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 3/7/2023
The date that a record was last updated or changed.
Provider Gender Code: M
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 174400000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 136080
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: NY
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 208600000X
Provider License Number 2: 136080
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: NY
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 208D00000X
Provider License Number 3: 136080
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: NY
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: Y
Other Provider Identifier 1: 136080
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: NY
Other Provider Identifier Issuer 1: LICENSE NUMBER
Other Provider Identifier 2: 1000016145
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: NY
Other Provider Identifier Issuer 2: AFFINITY PROVIDER NUMBER
Other Provider Identifier 3: CS126
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: NY
Other Provider Identifier Issuer 3: OXFORD PROVIDER NUMBER
Other Provider Identifier 4: 0041653
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: NY
Other Provider Identifier Issuer 4: AETNA PROVIDER NUMBER
Other Provider Identifier 5: 136080-9
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: NY
Other Provider Identifier Issuer 5: WORKERS COMP BOARD AUTH #
Other Provider Identifier 6: 26504P
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6: NY
Other Provider Identifier Issuer 6: HIP PRIS NUMBER
Other Provider Identifier 7: 7502
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: NY
Other Provider Identifier Issuer 7: VYTRA PROVIDER NUMBER
Is Sole Proprietor: Y
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
NPI Certification Date: 10/28/2021