Provider Demographics
NPI:1083727861
Name:KAHN, EDWIN (PHD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:KAHN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W 97TH ST
Mailing Address - Street 2:SUITE 1J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6053
Mailing Address - Country:US
Mailing Address - Phone:212-666-8616
Mailing Address - Fax:
Practice Address - Street 1:50 W 97TH ST
Practice Address - Street 2:SUITE 1J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6053
Practice Address - Country:US
Practice Address - Phone:212-666-8616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005034-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01062046Medicaid
NYR53536Medicare UPIN
NY01062046Medicaid