MEDICARE: DR. WILLIAM ALOYSIUS KENNEDY III 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
1	207Y00000X	Otolaryngology Physician	252884	NY

General Provider Information

NPI Number	:	1649410309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM ALOYSIUS KENNEDY III M.D.

Provider Business Mailing Address
First Line	:	215 MIDDLE NECK RD STE B16-2B
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-1170
Country	:	US
Telephone Number	:	516-313-1027
Fax Number	:	646-657-0347

Provider Business Practice Location Address
First Line	:	200 MIDDLE NECK RD STE H
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-1107
Country	:	US
Telephone Number	:	516-313-1027
Fax Number	:	646-657-0347

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	11/19/2021

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