Healthcare Provider Details

I. General information

NPI: 1427679257
Provider Name (Legal Business Name): ALEXANDRA MCMULLEN KENNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OCEAN PKWY
BROOKLYN NY
11235-7745
US

IV. Provider business mailing address

300 E 93RD ST APT 18D
NEW YORK NY
10128-6105
US

V. Phone/Fax

Practice location:
  • Phone: 718-616-4636
  • Fax: 718-616-5037
Mailing address:
  • Phone: 617-930-0984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number324807
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: