Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 239314 | NY |
NPI | 1235394255 |
---|---|
Provider Name | Dr. Timothy John Kennedy |
First Address | New York, NY 10023-5957 |
Second Address | New Brunswick, NJ 08901-1914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2008 |
Last Update Date | 27/03/2015 |