Provider Demographics
NPI:1134443112
Name:KAHN, MARK ROBERT
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ROBERT
Last Name:KAHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 JERICHO TPKE
Mailing Address - Street 2:STE 204
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 JERICHO TPKE
Practice Address - Street 2:STE 204
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4538
Practice Address - Country:US
Practice Address - Phone:516-496-4141
Practice Address - Fax:516-496-4393
Is Sole Proprietor?:No
Enumeration Date:2010-03-20
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265075207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease