Individual
KENNETH EUGENE COOMBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
154 TERRY RD, SMITHTOWN, NY 11787-5103
(631) 724-8285
(631) 724-1598
Mailing address
154 TERRY RD, SMITHTOWN, NY 11787-5103
(631) 724-8285
(631) 724-1598
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
518-025
WI
213E00000X
Podiatrist
Primary
NOO 37201-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011725369
—
NY
Enumeration date
08/09/2005
Last updated
12/21/2011
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