Provider Demographics
NPI:1063000362
Name:ADEN, MOKTAR
Entity Type:Individual
Prefix:
First Name:MOKTAR
Middle Name:
Last Name:ADEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 NEW BRIGHTON BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418
Mailing Address - Country:US
Mailing Address - Phone:651-366-0140
Mailing Address - Fax:
Practice Address - Street 1:2500 NEW BRIGHTON BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAINT ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418
Practice Address - Country:US
Practice Address - Phone:651-366-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician