Healthcare Provider Details

I. General information

NPI: 1396487641
Provider Name (Legal Business Name): JESSE ANNA KENNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 233RD ST
BRONX NY
10466-2604
US

IV. Provider business mailing address

711 FARMINGTON AVE APT A17
WEST HARTFORD CT
06119-1768
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-9000
  • Fax:
Mailing address:
  • Phone: 203-401-1305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number344125
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: