Individual
KENNETH HENRY HILBORNE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4 COMMERCE LANE, CANTON, NY 13617
(315) 386-8191
(315) 386-1410
Mailing address
605 ELIZABETH ST, OGDENSBURG, NY 13669
(315) 393-4728
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F330919
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01995615
—
NY
01
—
161568985LAI
BCBS
—
Enumeration date
03/10/2006
Last updated
12/10/2009
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