Healthcare Provider Details

I. General information

NPI: 1629930235
Provider Name (Legal Business Name): MARLENA OLIENSIS CBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 DRIGGS AVE APT 4
BROOKLYN NY
11211-5533
US

IV. Provider business mailing address

804 DRIGGS AVE APT 4
BROOKLYN NY
11211-5533
US

V. Phone/Fax

Practice location:
  • Phone: 845-653-6994
  • Fax:
Mailing address:
  • Phone: 845-653-6994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: