=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659363356
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARVIN DEN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2005
-----------------------------------------------------
Last Update Date | 03/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 CROSS ST 4TH FL
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06851-4647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-845-4800
-----------------------------------------------------
Fax | 203-845-4873
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2700 WESTCHESTER AVE
-----------------------------------------------------
City | PURCHASE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10577-2547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-607-5730
-----------------------------------------------------
Fax | 914-457-1195
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | 022759
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 022759
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------