Healthcare Provider Details

I. General information

NPI: 1467641449
Provider Name (Legal Business Name): MARILYN BIEN-AIME APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22022 HILLSIDE AVE
QUEENS VILLAGE NY
11427-2020
US

IV. Provider business mailing address

41 KENMORE RD
VALLEY STREAM NY
11581-2103
US

V. Phone/Fax

Practice location:
  • Phone: 718-975-7300
  • Fax: 718-464-7508
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number26NJ00131900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00131900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number336671
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: