Provider Demographics
NPI:1336152917
Name:KAHN, JUDITH EVE (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:EVE
Last Name:KAHN
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 1:3660 OXFORD AVE
Mailing Address - Street 2:# 7G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1728
Mailing Address - Country:US
Mailing Address - Phone:718-884-8115
Mailing Address - Fax:718-884-1487
Practice Address - Street 1:545 W 236TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1710
Practice Address - Country:US
Practice Address - Phone:718-884-8115
Practice Address - Fax:718-884-1487
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163381-2208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00906189Medicaid
A63072Medicare UPIN
63K372Medicare ID - Type Unspecified