Provider Demographics
NPI:1982604831
Name:KENNY, RAYMOND PATRICK (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:PATRICK
Last Name:KENNY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4626
Mailing Address - Country:US
Mailing Address - Phone:845-338-1535
Mailing Address - Fax:845-338-0301
Practice Address - Street 1:396 BROADWAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4626
Practice Address - Country:US
Practice Address - Phone:845-338-1535
Practice Address - Fax:845-338-0301
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA47899207RG0100X
NY324172207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222971684OtherHORIZON BC/BS NJ
NJ18B851OtherWELL CHOICE
NYD07022Medicare UPIN
NJKE192289Medicare PIN