Provider Demographics
NPI:1962423145
Name:SIMON KAHN MD PC
Entity type:Organization
Organization Name:SIMON KAHN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-567-2206
Mailing Address - Street 1:464 HUDSON TER
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2902
Mailing Address - Country:US
Mailing Address - Phone:201-567-2206
Mailing Address - Fax:201-567-1120
Practice Address - Street 1:464 HUDSON TER
Practice Address - Street 2:SUITE 201
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2902
Practice Address - Country:US
Practice Address - Phone:201-567-2206
Practice Address - Fax:201-567-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46175207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ102171Medicare PIN