MEDICARE: KENNETH FUNNY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	F92884317402012	NJ

General Provider Information

NPI Number	:	1215800842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH FUNNY

Provider Business Mailing Address
First Line	:	3815 10TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-5707
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3815 10TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-5707
Country	:	US
Telephone Number	:	201-982-0744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	10/23/2025

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Directions to “ KENNETH FUNNY ” Practice Location

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