Provider Demographics
NPI:1609312354
Name:FEENEY, KEVIN SEAN (MSED)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:SEAN
Last Name:FEENEY
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 GABRIEL AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-2445
Mailing Address - Country:US
Mailing Address - Phone:917-923-1437
Mailing Address - Fax:
Practice Address - Street 1:957 GABRIEL AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-2445
Practice Address - Country:US
Practice Address - Phone:917-923-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334395031174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist