Provider Demographics
NPI:1932721867
Name:KREIDIEH, MALEK (MD,)
Entity Type:Individual
Prefix:
First Name:MALEK
Middle Name:
Last Name:KREIDIEH
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 1:538 SEAVIEW AVENUE
Mailing Address - Street 2:APARTMENT 538B
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:929-428-3259
Mailing Address - Fax:718-226-1347
Practice Address - Street 1:475 SEAVIEW AVENUE
Practice Address - Street 2:STATEN ISLAND UNIVERSITY HOSPITAL, DEPARTMENT OF INTERN
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-226-9000
Practice Address - Fax:718-226-1347
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2022-02-23
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2022-02-23
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY244202390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program