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General NPI Number Information
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NPI Number | 1447092853
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Entity Type | Organization
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Legal Business Name | CORT CHEDWIN KENNEDY MD PLLC
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 229 RAILROAD AVE STE 3
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City | SAYVILLE
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State | NY
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Zip | 11782-2719
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Country | US
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Telephone | 631-507-2979
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Fax |
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Provider Business Mailing Address
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Address Line | 364 VANDERBILT BLVD
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City | OAKDALE
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State | NY
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Zip | 11769-2038
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CORT CHEDWIN KENNEDY II
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Credential | MD
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Telephone | 631-507-2979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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