Provider Demographics
NPI:1679877740
Name:KENNETH KAHANER M.D.
Entity type:Organization
Organization Name:KENNETH KAHANER M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHANER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-829-6978
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-7559
Mailing Address - Country:US
Mailing Address - Phone:516-629-2470
Mailing Address - Fax:516-629-2452
Practice Address - Street 1:15 BARSTOW RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2211
Practice Address - Country:US
Practice Address - Phone:516-829-6978
Practice Address - Fax:516-829-9632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1365502084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty