Provider Demographics
NPI:1023645587
Name:KENNEDY, JOHN WILLIAM JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:KENNEDY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NICOLLS RD
Mailing Address - Street 2:DEPARTMENT OF ORTHOPAEDICS/HSC T-18-089
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8181
Mailing Address - Country:US
Mailing Address - Phone:631-444-1487
Mailing Address - Fax:
Practice Address - Street 1:101 NICOLLS RD
Practice Address - Street 2:DEPARTMENT OF ORTHOPAEDICS/HSC T-18-089
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8181
Practice Address - Country:US
Practice Address - Phone:631-444-1487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program