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NPI Code Detail

MEDICARE: DR. KEVIN JOHN KENNY M.D.

MEDICARE: DR. KEVIN JOHN KENNY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician176760NY

General Provider Information

NPI Number : 1417089699
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN JOHN KENNY M.D.
Provider Business Mailing Address
First Line : 3052 AVENUE R
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-2636
Country : US
Telephone Number : 718-376-7068
Fax Number : 718-429-5146
Provider Business Practice Location Address
First Line : 3312 SURF AVE # 30
Second Line :
City : BROOKLYN
State : NY
Zip : 11224-1406
Country : US
Telephone Number : 718-449-4000
Fax Number : 719-448-5146
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2007
Last Update Date : 07/08/2007

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