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General NPI Number Information
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NPI Number | 1780306290
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Entity Type | Organization
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Legal Business Name | KENNEDY PSYCHIATRIC PC
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 1160 5TH AVE APT 112
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City | NEW YORK
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State | NY
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Zip | 10029-6933
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Country | US
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Telephone | 929-505-0504
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Fax |
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Provider Business Mailing Address
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Address Line | 120 BIRCHWOOD AVE
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City | NYACK
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State | NY
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Zip | 10960-1202
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Country | US
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Telephone | 929-434-0724
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NIGEL IAIN KENNEDY
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Credential | MD
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Telephone | 929-505-0504
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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 |
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License Number State |
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