=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982604831
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAYMOND PATRICK KENNY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2005
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 396 BROADWAY
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12401-4626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-338-1535
-----------------------------------------------------
Fax | 845-338-0301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 396 BROADWAY
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12401-4626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-338-1535
-----------------------------------------------------
Fax | 845-338-0301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | MA47899
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 324172
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------