Provider Demographics
NPI:1497893077
Name:HAHN, REBECCA T (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:T
Last Name:HAHN
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 1:320 W END AVE
Mailing Address - Street 2:APT 5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-8110
Mailing Address - Country:US
Mailing Address - Phone:212-595-6426
Mailing Address - Fax:
Practice Address - Street 1:630 W 168TH ST # 93
Practice Address - Street 2:PH 3-STEM 137
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:212-305-4712
Practice Address - Fax:212-342-3414
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163707207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01176663Medicaid
A60645Medicare UPIN
91A73Medicare ID - Type Unspecified