Healthcare Provider Details

I. General information

NPI: 1275570202
Provider Name (Legal Business Name): ROGER KAHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 02/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 ALBANY POST RD BLDG 1, ROOM 115, HOSPITAL BASE CARE LINE
MONTROSE NY
10548-1454
US

IV. Provider business mailing address

PO BOX 750762 106-28 QUEENS BLVD
FOREST HILLS NY
11375-0762
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-4400
  • Fax:
Mailing address:
  • Phone: 347-338-9242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number126209
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number126209
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: