Healthcare Provider Details

I. General information

NPI: 1750387544
Provider Name (Legal Business Name): JOSEPH S KENNEY III D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2005
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BALA AVE STE 300
BALA CYNWYD PA
19004-3207
US

IV. Provider business mailing address

1 BALA AVE STE 300
BALA CYNWYD PA
19004-3207
US

V. Phone/Fax

Practice location:
  • Phone: 610-660-9910
  • Fax: 610-660-9920
Mailing address:
  • Phone: 610-660-9910
  • Fax: 610-660-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS006801E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: