Provider Demographics
NPI:1225027568
Name:KENNETT, SHAR (MD)
Entity Type:Individual
Prefix:
First Name:SHAR
Middle Name:
Last Name:KENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 RXR PLZ FL 13
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-1301
Mailing Address - Country:US
Mailing Address - Phone:516-453-0435
Mailing Address - Fax:
Practice Address - Street 1:32 JOURNAL SQ
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4002
Practice Address - Country:US
Practice Address - Phone:201-354-1955
Practice Address - Fax:201-354-1956
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06427100207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG13292Medicare UPIN
NJ901179BSDMedicare ID - Type UnspecifiedMEDICARE#