Provider Demographics
NPI:1407922297
Name:KAHN, ELLEN IDA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:IDA
Last Name:KAHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SHEEP PASTURE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-5135
Mailing Address - Country:US
Mailing Address - Phone:631-692-8548
Mailing Address - Fax:
Practice Address - Street 1:233 E SHORE RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2433
Practice Address - Country:US
Practice Address - Phone:516-487-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128596174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO4790Medicare UPIN