Individual
COLLIN KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
212 COAST GUARD DR, STATEN ISLAND, NY 10305-5005
(718) 354-4353
Mailing address
212 COAST GUARD DR, STATEN ISLAND, NY 10305-5005
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
04/17/2026
Last updated
04/17/2026
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