Organization
CCS MEDICAL PRACTICE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL KENNEDY D.O. (OWNER)
(631) 923-2139
Entity
Organization
Contact information
Practice address
17 SOUTHDOWN ROAD, HUNTINGTON, NY 11743
(631) 923-2139
Mailing address
17 SOUTHDOWN ROAD, HUNTINGTON, NY 11743
(301) 809-4000
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
7175553
NY
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/21/2014
Last updated
12/16/2019
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