Provider Demographics
NPI:1750490314
Name:SVENSSON, KENNETH BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:BARRY
Last Name:SVENSSON
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 1:46 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2623
Mailing Address - Country:US
Mailing Address - Phone:845-353-0202
Mailing Address - Fax:845-353-3819
Practice Address - Street 1:46 N BROADWAY
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2623
Practice Address - Country:US
Practice Address - Phone:845-353-0202
Practice Address - Fax:845-353-3819
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01186561Medicaid
NY02E541Medicare ID - Type Unspecified
NYE87216Medicare UPIN