Healthcare Provider Details

I. General information

NPI: 1932721867
Provider Name (Legal Business Name): MALEK KREIDIEH M.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date: 01/17/2022
Reactivation Date: 02/23/2022

III. Provider practice location address

475 SEAVIEW AVENUE STATEN ISLAND UNIVERSITY HOSPITAL, DEPARTMENT OF INTERN
STATEN ISLAND NY
10305
US

IV. Provider business mailing address

538 SEAVIEW AVE APT 538B
STATEN ISLAND NY
10305-3406
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-9000
  • Fax: 718-226-1347
Mailing address:
  • Phone: 929-428-3259
  • Fax: 718-226-1347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number323927-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number323927-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: