Healthcare Provider Details

I. General information

NPI: 1619670981
Provider Name (Legal Business Name): BRANDON AVRAHAM KAHEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

115 COLONIAL RD
GREAT NECK NY
11021-2729
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-1548
  • Fax:
Mailing address:
  • Phone: 516-697-0797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number343254-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: