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MARY T KENNEDY
OTHER
MARY T KENNEDY is physician registered in the Centers for Medicare & Medicaid Services (CMS). The National Provider Identifier (NPI) of the National Plan and Provider Enumeration System (NPPES) is 1861479636. The unique individual professional ID assigned by Provider Enrollment, Chain, and Ownership System (PECOS) is 8921296054. The primary specialty is . The organization is . The address is 21704 NORTHERN BLVD, SUITE 16, BAYSIDE, NY, 113613500. The zip code is 113613500.
| Nation Provider ID | 1861479636 |
|---|---|
| PAC ID by PECOS | 8921296054 |
| Professional Enrollment ID | I20101216000144 |
| Name | MARY T KENNEDY |
| Medical School Name | OTHER |
| Graduation Year | 1971 |
| Primary Specialty | |
| All secondary specialties | |
| Organization Name | |
| Group Practice PAC ID | |
| Number of Group Practice members | 0 |
| Address | 21704 NORTHERN BLVD, SUITE 16, BAYSIDE, NY, 113613500 |
| Hospital affiliation LBN | |
| Graduation Year | 1971 |
| Contact Number | 7186318939 |
| Email Address | [Show_Email_ID] |
| Phone Number | [Show_Phone] |
| Website | [Show_Website] |