Provider Demographics
NPI:1669578365
Name:KENNETH D NAHUM DO PC
Entity type:Organization
Organization Name:KENNETH D NAHUM DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:NAHUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-367-1535
Mailing Address - Street 1:4632 US HIGHWAY 9 S
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3380
Mailing Address - Country:US
Mailing Address - Phone:732-367-1535
Mailing Address - Fax:732-367-9514
Practice Address - Street 1:4632 US HIGHWAY 9
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04108600207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7026200Medicaid
NJ7026200Medicaid
NJ839337Medicare PIN
NJI22373Medicare UPIN