Individual
DR. JOHN J KENNEDY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1675 PROVIDENCE AVE, SCHENECTADY, NY 12309
(518) 377-3439
(518) 377-0436
Mailing address
1675 PROVIDENCE AVE, SCHENECTADY, NY 12309
(518) 377-3439
(518) 377-0436
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
1390921
NY
207W00000X
Ophthalmology Physician
D0021006
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00747291
—
NY
01
—
10001040
CDPHP
—
01
—
17108
MVP
—
Enumeration date
06/09/2006
Last updated
05/03/2016
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