| Doctor Name: | DR. KENNETH IHENETU |
| NPI Number: | 1083075212 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD, DABCC, FACB |
| License Number: | IHENK1 |
| Business Practice Address: | 785 Delaware Ave Fl 1 Delmar, NY - 120549713 |
| Business Phone Number: | 3619449554 |
| Business Fax Number: | |
| Mailing Address: | 785 Delaware Ave, Fl1, DELMAR |
| State: | NY |
| Postal Code: | 12054 |
| Phone Number: | 3619449554 |
| Fax Number: | |
| NPI Enumeration Date: | 03/16/2016 |
| NPI Last Update Date: | 03/16/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 247ZC0005X |
| License Number: | IHENK1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Pathology |
| Taxonomy Specialization: | Clinical Laboratory Director, Non-physician |
| Taxonomy Definition: | An individual who is state-licensed as a clinical laboratory director and meets the qualifications in the Clinical Laboratory Improvement Amendments of 1988 for non-physicians (non-MD/DO) as defined in the CFR 42 Part 493.1405. |