Provider Demographics
NPI:1912416165
Name:AHN, JOHN (NP-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:AHN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 HAMBURG TPKE RM 4023
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2149
Mailing Address - Country:US
Mailing Address - Phone:973-956-3357
Mailing Address - Fax:973-389-4050
Practice Address - Street 1:224 HAMBURG TPKE RM 4023
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2149
Practice Address - Country:US
Practice Address - Phone:973-956-3357
Practice Address - Fax:973-389-4050
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00751100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health