Healthcare Provider Details

I. General information

NPI: 1659363356
Provider Name (Legal Business Name): MARVIN DEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CROSS ST 4TH FL
NORWALK CT
06851-4647
US

IV. Provider business mailing address

2700 WESTCHESTER AVE
PURCHASE NY
10577-2547
US

V. Phone/Fax

Practice location:
  • Phone: 203-845-4800
  • Fax: 203-845-4873
Mailing address:
  • Phone: 914-607-5730
  • Fax: 914-457-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number022759
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number022759
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: