Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 026807-1 | NY |
NPI | 1104077403 |
---|---|
Provider Name | Mrs. Magen T Kennedy |
First Address | Bronxville, NY 10708-5305 |
Second Address | White Plains, NY 10605-2209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2008 |
Last Update Date | 05/10/2008 |