Healthcare Provider Details

I. General information

NPI: 1124099734
Provider Name (Legal Business Name): KENNETH NOAH GIEDD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 E 14TH ST
NEW YORK NY
10003-4243
US

IV. Provider business mailing address

455 E 51ST ST # 2C
NEW YORK NY
10022-6474
US

V. Phone/Fax

Practice location:
  • Phone: 212-481-3333
  • Fax:
Mailing address:
  • Phone: 212-969-9284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number183525
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number183525
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: