Provider Demographics
NPI:1780306290
Name:KENNEDY PSYCHIATRIC PC
Entity type:Organization
Organization Name:KENNEDY PSYCHIATRIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIGEL
Authorized Official - Middle Name:IAIN
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:929-505-0504
Mailing Address - Street 1:120 BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1202
Mailing Address - Country:US
Mailing Address - Phone:929-434-0724
Mailing Address - Fax:
Practice Address - Street 1:1160 5TH AVE APT 112
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6933
Practice Address - Country:US
Practice Address - Phone:929-505-0504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1538576277OtherINDIVIDUAL NPI