Provider Demographics
NPI:1326019118
Name:KENNISH, ARTHUR JAY (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:JAY
Last Name:KENNISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E 96TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6217
Mailing Address - Country:US
Mailing Address - Phone:212-410-6610
Mailing Address - Fax:212-348-0749
Practice Address - Street 1:108 E 96TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6217
Practice Address - Country:US
Practice Address - Phone:212-410-6610
Practice Address - Fax:212-348-0749
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135410207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00747902Medicaid
A63571Medicare UPIN
NY64A601Medicare PIN