Provider Demographics
NPI:1922079904
Name:NAHUM, KENNETH D (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:D
Last Name:NAHUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4632 ROUTE 9 S
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3319
Mailing Address - Country:US
Mailing Address - Phone:732-367-1535
Mailing Address - Fax:732-367-9514
Practice Address - Street 1:4632 ROUTE 9 S
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3319
Practice Address - Country:US
Practice Address - Phone:732-367-1535
Practice Address - Fax:732-367-9514
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04108600207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1819500Medicaid
NJC30700Medicare UPIN
NJ1819500Medicaid