Provider Demographics
NPI:1861574527
Name:HUML, KENNETH G (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:G
Last Name:HUML
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:285 SILLS RD
Mailing Address - Street 2:BUILDING 9 SUITE A
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4869
Mailing Address - Country:US
Mailing Address - Phone:631-475-0334
Mailing Address - Fax:631-475-2852
Practice Address - Street 1:285 SILLS RD
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:631-475-0334
Practice Address - Fax:631-475-2852
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist