MEDICARE: DR. CORT CHEDWIN KENNEDY II MD

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	207Q00000X	Family Medicine Physician	325220-01	NY

General Provider Information

NPI Number	:	1730719659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORT CHEDWIN KENNEDY II MD

Provider Business Mailing Address
First Line	:	229 RAILROAD AVE STE 3
Second Line	:
City	:	SAYVILLE
State	:	NY
Zip	:	11782-2719
Country	:	US
Telephone Number	:	631-909-6343
Fax Number	:	631-909-6344

Provider Business Practice Location Address
First Line	:	229 RAILROAD AVE STE 3
Second Line	:
City	:	SAYVILLE
State	:	NY
Zip	:	11782-2719
Country	:	US
Telephone Number	:	631-909-6342
Fax Number	:	631-909-6344

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

Provider Enumeration Date	:	01/20/2020
Last Update Date	:	01/27/2025

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