Provider Demographics
NPI:1578598314
Name:AHN, MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:AHN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 821034
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-1034
Mailing Address - Country:US
Mailing Address - Phone:973-429-8082
Mailing Address - Fax:973-748-0586
Practice Address - Street 1:122 CLINTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2502
Practice Address - Country:US
Practice Address - Phone:201-418-1415
Practice Address - Fax:201-418-3148
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215848207V00000X
NJ25MB06706900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7954506Medicaid
NY027540Medicare ID - Type Unspecified