Individual
MICHAEL KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
17 SOUTHDOWN RD, HUNTINGTON, NY 11743-2538
(631) 923-2139
(631) 923-2140
Mailing address
17 SOUTHDOWN RD, HUNTINGTON, NY 11743-2538
(631) 923-2139
(631) 923-2140
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
02524
NC
207P00000X
Emergency Medicine Physician
Primary
171806
NY
207P00000X
Emergency Medicine Physician
20A18353
CA
207P00000X
Emergency Medicine Physician
OS-006765-E
PA
207PS0010X
Sports Medicine (Emergency Medicine) Physician
420
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01071058
—
NY
Enumeration date
11/17/2006
Last updated
03/15/2022
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