Provider Demographics
NPI:1528623956
Name:KENNY, MERCY CRYZ
Entity type:Individual
Prefix:MRS
First Name:MERCY
Middle Name:CRYZ
Last Name:KENNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 THREE SISTERS RD
Mailing Address - Street 2:
Mailing Address - City:ST JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780
Mailing Address - Country:US
Mailing Address - Phone:631-584-2001
Mailing Address - Fax:631-584-2001
Practice Address - Street 1:12 THREE SISTERS RD
Practice Address - Street 2:
Practice Address - City:ST JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780
Practice Address - Country:US
Practice Address - Phone:631-584-2001
Practice Address - Fax:631-584-2001
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2192L0013747P1801X, 376J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker