MEDICARE: KHALED AHMED MARDEN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	003037	NY

General Provider Information

NPI Number	:	1770250375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHALED AHMED MARDEN DO

Provider Business Mailing Address
First Line	:	50 SEASIDE LN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-4754
Country	:	US
Telephone Number	:	929-578-4977
Fax Number	:

Provider Business Practice Location Address
First Line	:	613 W 169TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-2914
Country	:	US
Telephone Number	:	212-927-8039
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	08/23/2021

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Directions to “ KHALED AHMED MARDEN DO” Practice Location

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