Healthcare Provider Details

I. General information

NPI: 1932191038
Provider Name (Legal Business Name): SAMUEL KENAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 E 34TH ST
NYC NY
10016-4974
US

IV. Provider business mailing address

16 OLD SEARINGTOWN RD
ALBERTSON NY
11507-1532
US

V. Phone/Fax

Practice location:
  • Phone: 212-684-5511
  • Fax: 212-684-6611
Mailing address:
  • Phone: 516-248-7756
  • Fax: 212-684-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number181971
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: