Provider Demographics
NPI:1811213804
Name:ABDULLAH, MARWAN AMIN (RPH, CNS)
Entity Type:Individual
Prefix:MR
First Name:MARWAN
Middle Name:AMIN
Last Name:ABDULLAH
Suffix:
Gender:M
Credentials:RPH, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 GRAMATAN AVE.
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552
Mailing Address - Country:US
Mailing Address - Phone:914-665-5556
Mailing Address - Fax:914-665-5589
Practice Address - Street 1:505 GRAMATAN AVE.
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552
Practice Address - Country:US
Practice Address - Phone:914-665-5556
Practice Address - Fax:914-665-5589
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI046545-11835N1003X, 1835N1003X
NY046545-1183500000X
133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
16326OtherCBNS
NY01914543Medicaid
NY01914543Medicaid