Active NPI
Nicole Marie Kennedy, PNP
- Pediatric Urology Physician
- New York, NY
National Provider Identifier
1093405870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Urology Physician
- License
- 383523
- Practice address
- 5 E 98TH St
New York, NY 10029-6501 - Phone
- (212) 241-7640
- NPI assigned
- May 15, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Urology Physician | 2088P0231X | 383523 | NY | Primary |
Addresses
Primary practice location
5 E 98TH St
New York, NY 10029-6501
Mailing address
17 Mallard Dr
Greenwich, CT 06830-6707
Phone (203) 651-9178
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 383523 | NY | MD | Pediatric Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684108800000",
"number": "1093405870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 MALLARD DR",
"city": "GREENWICH",
"state": "CT",
"postal_code": "068306707",
"telephone_number": "203-651-9178"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 E 98TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100296501",
"telephone_number": "212-241-7640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "NICOLE",
"middle_name": "MARIE",
"credential": "PNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-05-15",
"last_updated": "2023-05-15",
"certification_date": "2023-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "2088P0231X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Urology, Pediatric Urology",
"state": "NY",
"license": "383523",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.