Provider Demographics
NPI:1073612768
Name:PEDIATRIC AND ADOLESCENT MEDICINE
Entity Type:Organization
Organization Name:PEDIATRIC AND ADOLESCENT MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER IN PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-787-1444
Mailing Address - Street 1:390 W END AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6107
Mailing Address - Country:US
Mailing Address - Phone:212-787-1444
Mailing Address - Fax:212-799-8620
Practice Address - Street 1:390 W END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6107
Practice Address - Country:US
Practice Address - Phone:212-787-1444
Practice Address - Fax:212-799-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty