Provider Demographics
NPI:1023017464
Name:KAHN, MARK R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:KAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 MERRICK RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2640
Mailing Address - Country:US
Mailing Address - Phone:516-599-4242
Mailing Address - Fax:516-599-4498
Practice Address - Street 1:260 W SUNRISE HWY
Practice Address - Street 2:SUITE 305
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1011
Practice Address - Country:US
Practice Address - Phone:516-791-8664
Practice Address - Fax:516-791-8420
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174507-1207N00000X, 207NS0135X
NY174507207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01836048Medicaid
NYF27843Medicare UPIN
NY43K691Medicare UPIN