Provider Demographics
NPI:1144333170
Name:SUBIN, KENNETH PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:PAUL
Last Name:SUBIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1301 TRUMANSBURG RD STE P
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1397
Mailing Address - Country:US
Mailing Address - Phone:607-277-2365
Mailing Address - Fax:607-277-1415
Practice Address - Street 1:16 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-339-0680
Practice Address - Fax:607-319-5532
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2018-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2440802083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03168114Medicaid
NYJ400066917Medicare PIN