Provider Demographics
NPI:1013097732
Name:KAHN, ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:KAHN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23-55 FAIR LAWN AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3407
Mailing Address - Country:US
Mailing Address - Phone:201-796-2873
Mailing Address - Fax:
Practice Address - Street 1:23-55 FAIR LAWN AVENUE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3407
Practice Address - Country:US
Practice Address - Phone:201-796-2873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4351152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4214237OtherCIGNA
NJP1088215OtherOXFORD
NJ0516598OtherAETNA
NJ223199290OtherHORIZON
NJ1013097732Medicare UPIN
NJ223199290OtherHORIZON
NJ521525Medicare PIN