Basic Information
| Provider Information | |||||||||
| NPI: | 1528019866 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SADEKNI | ||||||||
| FirstName: | MARWAN | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 W GILBERT ST | ||||||||
| Address2: | |||||||||
| City: | TINTON FALLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077014918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322120060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 PARK ST | ||||||||
| Address2: | |||||||||
| City: | HONESDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184311445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702538100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD031215E | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | MD031215E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000973982 | 05 | PA | MEDICAID |