Provider Demographics
NPI:1396712006
Name:KENNY, DANIELE J (MD)
Entity type:Individual
Prefix:
First Name:DANIELE
Middle Name:J
Last Name:KENNY
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 1:1312 MIDDLE COUNTRY ROAD
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784
Mailing Address - Country:US
Mailing Address - Phone:631-698-6556
Mailing Address - Fax:631-698-1021
Practice Address - Street 1:1312 MIDDLE COUNTRY ROAD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784
Practice Address - Country:US
Practice Address - Phone:631-698-6556
Practice Address - Fax:631-698-1021
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A60444Medicare UPIN
09F481Medicare ID - Type Unspecified