Provider Demographics
NPI:1629601786
Name:KAHN, ANDREW MARTIN (BA, ERYT, LMT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARTIN
Last Name:KAHN
Suffix:
Gender:M
Credentials:BA, ERYT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1453
Mailing Address - Country:US
Mailing Address - Phone:516-371-3715
Mailing Address - Fax:
Practice Address - Street 1:436 CENTRAL AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1928
Practice Address - Country:US
Practice Address - Phone:516-371-3715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021583225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist