Provider Demographics
NPI:1427653260
Name:HUMENICK, JOSEPH T JR
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
Last Name:HUMENICK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10299 NEW BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9196
Mailing Address - Country:US
Mailing Address - Phone:330-301-8275
Mailing Address - Fax:
Practice Address - Street 1:10299 NEW BUFFALO RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9196
Practice Address - Country:US
Practice Address - Phone:330-301-8275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant