Healthcare Provider Details

I. General information

NPI: 1023017464
Provider Name (Legal Business Name): MARK R KAHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 W SUNRISE HWY SUITE 305
VALLEY STREAM NY
11581-1011
US

IV. Provider business mailing address

266 MERRICK RD SUITE 201
LYNBROOK NY
11563-2640
US

V. Phone/Fax

Practice location:
  • Phone: 516-791-8664
  • Fax: 516-791-8420
Mailing address:
  • Phone: 516-599-4242
  • Fax: 516-599-4498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number174507-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number174507-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number174507
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: