Healthcare Provider Details

I. General information

NPI: 1578885653
Provider Name (Legal Business Name): JEFFREY M. AHN M.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 PARK AVE
NEW YORK NY
10016-3487
US

IV. Provider business mailing address

45 PARK AVE
NEW YORK NY
10016-3487
US

V. Phone/Fax

Practice location:
  • Phone: 212-714-9494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number175143
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number175143
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number175143
License Number StateNY

VIII. Authorized Official

Name: JEFFREY M. AHN
Title or Position: OWNER/PROVIDER
Credential: M.D.
Phone: 212-714-9494