Provider Demographics
NPI:1023115052
Name:KENNEDY, ROBERT DAVIS (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVIS
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2 TUDOR CITY PL
Mailing Address - Street 2:11BS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6800
Mailing Address - Country:US
Mailing Address - Phone:212-808-0222
Mailing Address - Fax:212-808-0303
Practice Address - Street 1:2844 OCEAN PKWY
Practice Address - Street 2:WARBASSE HOUSES
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7900
Practice Address - Country:US
Practice Address - Phone:718-714-5925
Practice Address - Fax:718-714-5936
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY172359207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE23979Medicare UPIN