Healthcare Provider Details

I. General information

NPI: 1083956114
Provider Name (Legal Business Name): ADAM KENNEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 ENGLE ST
ENGLEWOOD NJ
07631-1824
US

IV. Provider business mailing address

309 ENGLE ST STE 7
ENGLEWOOD NJ
07631-1822
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-7246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA10045700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MA10045700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: