Healthcare Provider Details

I. General information

NPI: 1629601786
Provider Name (Legal Business Name): ANDREW MARTIN KAHN BA, ERYT, LMT, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 CENTRAL AVE UNIT 1
CEDARHURST NY
11516-1928
US

IV. Provider business mailing address

989 E BROADWAY
WOODMERE NY
11598-1453
US

V. Phone/Fax

Practice location:
  • Phone: 516-371-3715
  • Fax:
Mailing address:
  • Phone: 516-371-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123483
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number021583
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: