Provider Demographics
NPI:1649490715
Name:KENNY, EDWARD THOMAS (MD)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:THOMAS
Last Name:KENNY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:310 WEST 72ND STREET
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2675
Mailing Address - Country:US
Mailing Address - Phone:212-799-5079
Mailing Address - Fax:212-799-8820
Practice Address - Street 1:310 WEST 72ND STREET
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2675
Practice Address - Country:US
Practice Address - Phone:212-799-5079
Practice Address - Fax:212-799-8820
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2048242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H19999Medicare UPIN