MEDICARE: JEFFREY M. AHN, M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207KA0200X	Allergy Physician	25MA06227400	NJ
2	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	25MA06227400	NJ
3	207Y00000X	Otolaryngology Physician	25MA06227400	NJ

General Provider Information

NPI Number	:	1477875540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY M. AHN, M.D., P.C.

Provider Business Mailing Address
First Line	:	1485 PALISADE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5346
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1485 PALISADE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5346
Country	:	US
Telephone Number	:	201-461-9400
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	JEFFREY AHN
Credential	:	M.D.
Telephone Number	:	201-461-9400

Provider Enumeration Date	:	02/17/2010
Last Update Date	:	02/17/2010

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