Provider Demographics
NPI:1265520696
Name:KAHN, JEFFREY S (PHD CGP DABPS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:KAHN
Suffix:
Gender:M
Credentials:PHD CGP DABPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:482 SPRINGFIELD AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2601
Mailing Address - Country:US
Mailing Address - Phone:908-273-5558
Mailing Address - Fax:908-273-3355
Practice Address - Street 1:482 SPRINGFIELD AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2601
Practice Address - Country:US
Practice Address - Phone:908-273-5558
Practice Address - Fax:908-273-3355
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ2656103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ608099V6ZMedicare UPIN