Provider Demographics
NPI:1770250375
Name:MARDEN, KHALED AHMED (DO)
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:AHMED
Last Name:MARDEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SEASIDE LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4754
Mailing Address - Country:US
Mailing Address - Phone:929-578-4977
Mailing Address - Fax:
Practice Address - Street 1:613 W 169TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2914
Practice Address - Country:US
Practice Address - Phone:212-927-8039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003037171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist