=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255505517
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN G. KENNEDY, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2008
-----------------------------------------------------
Last Update Date | 07/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 535 E 70TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-4872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-797-8880
-----------------------------------------------------
Fax | 212-717-1016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 535 E 70TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-4872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-797-8880
-----------------------------------------------------
Fax | 212-717-1016
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHOPAEDIC SURGEON
-----------------------------------------------------
Name | JOHN G KENNEDY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 646-797-8880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 230567
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------