Provider Demographics
NPI:1306817309
Name:KINNEARY, DENNIS (PT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:KINNEARY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 ROGER DR
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2528
Mailing Address - Country:US
Mailing Address - Phone:516-570-2745
Mailing Address - Fax:
Practice Address - Street 1:1350 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3004
Practice Address - Country:US
Practice Address - Phone:516-365-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02008401OtherAETNA ORTHONET
NY169333POtherHIP
NY2C6913OtherHEALTHNET
PA66496OtherBLUE SHIELD
NYP1536005OtherOXFORD
NY080005505NY02OtherANTHEM
NY2114203OtherAETNA/US HEALTH
NYAZ00867OtherMDNY
NY45771OtherBLUE SHIELD
NYAZ00867OtherMDNY