Provider Demographics
NPI:1336109875
Name:AIDEN, KANWARDEEP SINGH (MD)
Entity Type:Individual
Prefix:
First Name:KANWARDEEP
Middle Name:SINGH
Last Name:AIDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 HUGUENOT AVE
Mailing Address - Street 2:STE A
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1119
Mailing Address - Country:US
Mailing Address - Phone:718-948-3474
Mailing Address - Fax:718-948-3446
Practice Address - Street 1:444 HUGUENOT AVE
Practice Address - Street 2:STE A
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1119
Practice Address - Country:US
Practice Address - Phone:718-948-3474
Practice Address - Fax:718-948-3446
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207334207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY794201OtherPTAN
NY01840555Medicaid
NY01840555Medicaid