Healthcare Provider Details

I. General information

NPI: 1790935294
Provider Name (Legal Business Name): ADRIAN MARCHIDANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

343 GOLD ST APT 2905
BROOKLYN NY
11201-3055
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-2051
  • Fax:
Mailing address:
  • Phone: 718-855-4281
  • Fax: 718-855-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number263981
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: