Provider Demographics
NPI:1699838128
Name:KAMEN, MAZEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAZEN
Middle Name:
Last Name:KAMEN
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 1:1021 PARK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0959
Mailing Address - Country:US
Mailing Address - Phone:212-427-5800
Mailing Address - Fax:212-996-9943
Practice Address - Street 1:1021 PARK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0959
Practice Address - Country:US
Practice Address - Phone:212-427-5800
Practice Address - Fax:212-996-9943
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162751207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA60965Medicare UPIN
NY17E651Medicare ID - Type Unspecified