Healthcare Provider Details

I. General information

NPI: 1386322154
Provider Name (Legal Business Name): MARWA AHMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1854 HYLAN BLVD STE 2
STATEN ISLAND NY
10305-2119
US

IV. Provider business mailing address

1854 HYLAN BLVD STE 2
STATEN ISLAND NY
10305-2119
US

V. Phone/Fax

Practice location:
  • Phone: 917-553-0424
  • Fax:
Mailing address:
  • Phone: 917-553-0424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: