Provider Demographics
NPI:1568809879
Name:MAKEN, NADEEM HUSSAAIN (TRANSPORT PROVIDER)
Entity Type:Individual
Prefix:MR
First Name:NADEEM
Middle Name:HUSSAAIN
Last Name:MAKEN
Suffix:
Gender:M
Credentials:TRANSPORT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 FORT BROWN DR APT 102
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12903-4903
Mailing Address - Country:US
Mailing Address - Phone:518-565-0440
Mailing Address - Fax:
Practice Address - Street 1:41 FORT BROWN DR APT 102
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-4903
Practice Address - Country:US
Practice Address - Phone:518-565-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDOT # 38812343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)