Basic Information
| Provider Information | |||||||||
| NPI: | 1821245325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENNEDY | ||||||||
| FirstName: | BYRON | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, PHD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 607 MAIN AVE | ||||||||
| Address2: | AFC NORWALK | ||||||||
| City: | NORWALK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038459100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 607 MAIN AVE | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038459100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2008 | ||||||||
| LastUpdateDate: | 12/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0901X | 252947 | NY | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine | 2083P0901X | 054178 | CT | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine | 208D00000X | 054178 | CT | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | 252947 | NY | N | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.