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General NPI Number Information
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NPI Number | 1649410309
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Entity Type | Individual
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Provider Name | WILLIAM ALOYSIUS KENNEDY III M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 200 MIDDLE NECK RD STE H
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City | GREAT NECK
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State | NY
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Zip | 11021-1107
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Country | US
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Telephone | 516-313-1027
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Fax | 646-657-0347
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Provider Business Mailing Address
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Address Line | 215 MIDDLE NECK RD STE B16-2B
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City | GREAT NECK
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State | NY
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Zip | 11021-1170
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Country | US
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Telephone | 516-313-1027
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Fax | 646-657-0347
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 252884
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License Number State | NY
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