Provider Demographics
NPI:1740326305
Name:AHN, JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:AHN
Suffix:
Gender:M
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:PO BOX 734
Mailing Address - Street 2:FDR STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10150-0734
Mailing Address - Country:US
Mailing Address - Phone:212-714-9494
Mailing Address - Fax:212-481-3629
Practice Address - Street 1:45 PARK AVE
Practice Address - Street 2:1ST FL.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3494
Practice Address - Country:US
Practice Address - Phone:212-714-9494
Practice Address - Fax:212-481-3629
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175143174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY46I042Medicare ID - Type Unspecified