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General NPI Number Information
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NPI Number | 1417089699
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Entity Type | Individual
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Provider Name | KEVIN JOHN KENNY M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3312 SURF AVE # 30
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City | BROOKLYN
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State | NY
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Zip | 11224-1406
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Country | US
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Telephone | 718-449-4000
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Fax | 719-448-5146
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Provider Business Mailing Address
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Address Line | 3052 AVENUE R
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City | BROOKLYN
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State | NY
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Zip | 11229-2636
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Country | US
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Telephone | 718-376-7068
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Fax | 718-429-5146
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 176760
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License Number State | NY
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