Provider Demographics
NPI:1861454480
Name:KENIS, GEORGE JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JAMES
Last Name:KENIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 N BELFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4836
Mailing Address - Country:US
Mailing Address - Phone:610-789-4564
Mailing Address - Fax:610-789-3159
Practice Address - Street 1:2 N BELFIELD AVE
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4836
Practice Address - Country:US
Practice Address - Phone:610-789-4564
Practice Address - Fax:610-789-3159
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004416L208000000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008995080001Medicaid
PAB36279Medicare UPIN
PA0008995080001Medicaid