Provider Demographics
NPI:1013364579
Name:AHN, ALEXANDER K
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:K
Last Name:AHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 HUDSON ST
Mailing Address - Street 2:#306
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5617
Mailing Address - Country:US
Mailing Address - Phone:917-592-7644
Mailing Address - Fax:
Practice Address - Street 1:86 HUDSON ST
Practice Address - Street 2:#306
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5617
Practice Address - Country:US
Practice Address - Phone:917-592-7644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-15
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00654600225700000X
NY027893-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist