Healthcare Provider Details

I. General information

NPI: 1255505517
Provider Name (Legal Business Name): JOHN G. KENNEDY, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST
NEW YORK NY
10021-4872
US

IV. Provider business mailing address

535 E 70TH ST
NEW YORK NY
10021-4872
US

V. Phone/Fax

Practice location:
  • Phone: 646-797-8880
  • Fax: 212-717-1016
Mailing address:
  • Phone: 646-797-8880
  • Fax: 212-717-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number230567
License Number StateNY

VIII. Authorized Official

Name: JOHN G KENNEDY
Title or Position: ORTHOPAEDIC SURGEON
Credential: MD
Phone: 646-797-8880