Healthcare Provider Details

I. General information

NPI: 1265520696
Provider Name (Legal Business Name): JEFFREY S KAHN PHD CGP DABPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 SPRINGFIELD AVE 2ND FLOOR
SUMMIT NJ
07901-2601
US

IV. Provider business mailing address

482 SPRINGFIELD AVE 2ND FLOOR
SUMMIT NJ
07901-2601
US

V. Phone/Fax

Practice location:
  • Phone: 908-273-5558
  • Fax: 908-273-3355
Mailing address:
  • Phone: 908-273-5558
  • Fax: 908-273-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2656
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: