Healthcare Provider Details

I. General information

NPI: 1710245717
Provider Name (Legal Business Name): MARWA ABDOU M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2054
US

IV. Provider business mailing address

451 CLARKSON AVE
BROOKLYN NY
11203-2054
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-3611
  • Fax: 718-245-3729
Mailing address:
  • Phone: 718-245-3611
  • Fax: 718-245-3729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number301499
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: