MEDICARE: CORT CHEDWIN KENNEDY MD PLLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1447092853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORT CHEDWIN KENNEDY MD PLLC

Provider Business Mailing Address
First Line	:	364 VANDERBILT BLVD
Second Line	:
City	:	OAKDALE
State	:	NY
Zip	:	11769-2038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	229 RAILROAD AVE STE 3
Second Line	:
City	:	SAYVILLE
State	:	NY
Zip	:	11782-2719
Country	:	US
Telephone Number	:	631-507-2979
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CORT CHEDWIN KENNEDY II
Credential	:	MD
Telephone Number	:	631-507-2979

Provider Enumeration Date	:	06/07/2024
Last Update Date	:	12/27/2024

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