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General NPI Number Information
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NPI Number | 1396919478
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Entity Type | Organization
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Legal Business Name | THE DR. KENNY CLINIC, P.C.
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 256 HAMILTON ST
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550
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Country | US
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Telephone | 508-764-6166
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Fax |
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Provider Business Mailing Address
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Address Line | 256 HAMILTON ST
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550
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Country | US
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Telephone | 508-764-6166
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNY HASIJA
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Credential |
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Telephone | 508-764-6166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35946
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License Number State | MA
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