Paul Vincent Kennedy, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

38919 Issued in NJ

Practice address

117 Watchung Ave
2ND Floor
Montclair, NJ 07043-1710

Phone

(973) 783-2984

Fax

(973) 783-5074

NPI assigned

Jun 3, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Behavioral Health Specialist at Highland LLC

  • Psychiatry Physician
  • Montclair, NJ
  • NPI 1730410481
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282176000000",
    "number": "1194763904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 FAIRFIELD ST",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070424113",
            "telephone_number": "973-783-2984",
            "fax_number": "973-783-5074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 WATCHUNG AVE",
            "address_2": "2ND FLOOR",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070431710",
            "telephone_number": "973-783-2984",
            "fax_number": "973-783-5074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "PAUL",
        "middle_name": "VINCENT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2010-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "38919",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NJ",
            "license": "38919",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00836064",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0224804",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keep Creating Corp
• Stuart Ross Keil, R. PH.
• Lydia Nicole Keise, M.D.
• Kaitlin Kelly
• Erika Kendrick, LPC
• Kenneth Y. Davis D.C.P.C.
• Amy Kenny
• Davia Kenton, LAC
• Megan J Kera, PA-C
• Shari Shante Kerr, LCSW

• Psychiatry Physician in Montclair, NJ
• Providers in Montclair, NJ by specialty
• Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.