Provider Demographics
NPI:1447092853
Name:CORT CHEDWIN KENNEDY MD PLLC
Entity type:Organization
Organization Name:CORT CHEDWIN KENNEDY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORT
Authorized Official - Middle Name:CHEDWIN
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:631-507-2979
Mailing Address - Street 1:364 VANDERBILT BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-2038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:229 RAILROAD AVE STE 3
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2719
Practice Address - Country:US
Practice Address - Phone:631-507-2979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-07
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care