Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 172359 | NY |
NPI | 1023115052 |
---|---|
Provider Name | Robert Davis Kennedy |
First Address | New York, NY 10017-6800 |
Second Address | Brooklyn, NY 11235-7900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E23979 | (02) | NY |