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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 ID1861479636
PAC ID by PECOS8921296054
Professional Enrollment IDI20101216000144
NameMARY T KENNEDY
Medical School NameOTHER
Graduation Year1971
Primary Specialty
All secondary specialties
Organization Name
Group Practice PAC ID
Number of Group Practice members0
Address21704 NORTHERN BLVD, SUITE 16, BAYSIDE, NY, 113613500
Hospital affiliation LBN
Graduation Year1971
Contact Number7186318939
Email Address[Show_Email_ID]
Phone Number[Show_Phone]
Website [Show_Website]