Provider Demographics
NPI:1932518818
Name:KAHEN, PERELA (DPT)
Entity Type:Individual
Prefix:
First Name:PERELA
Middle Name:
Last Name:KAHEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 NORTHERN BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4700
Mailing Address - Country:US
Mailing Address - Phone:516-918-9509
Mailing Address - Fax:516-918-9510
Practice Address - Street 1:287 NORTHERN BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4700
Practice Address - Country:US
Practice Address - Phone:516-918-9509
Practice Address - Fax:516-918-9510
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300121854Medicare PIN