ETHAN KENNEDY DO
NPI 1326807462
Student in an Organized Health Care Education/Training Program in Rochester, NY
About Ethan Kennedy Do NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ETHAN KENNEDY DO (NPI 1326807462) is an individual student in an organized health care education/training program in Rochester, New York and active in the NPI registry since March 2024. He is enrolled in Medicare PECOS and maintains a secondary practice location in North Charleston.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ethan Kennedy Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Ethan Kennedy's NPI number?
The NPI number for Ethan Kennedy is 1326807462. It was assigned to this individual provider in the NPPES registry on March 18, 2024.
Where is Ethan Kennedy located?
Ethan Kennedy practices at 1425 Portland Ave, Rochester, NY 14621. The listed phone number is (585) 922-4683.
What is Ethan Kennedy's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Ethan Kennedy enrolled in Medicare?
Yes. Ethan Kennedy is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Ethan Kennedy was last updated on June 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Ethan Kennedy, DO · NPI 1326807462
Student in an Organized Health Care Education/Training Program provider in Rochester, New York. Individual provider, active in the CMS NPPES registry since March 18, 2024.
## Identity
- **NPI:** 1326807462 (Entity type: Individual)
- **Enumerated:** March 18, 2024
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **Sole proprietor:** No
## Practice location
- **Address:** 1425 PORTLAND AVE, Rochester, NY 14621-3011
- **Phone:** (585) 922-4683
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** June 11, 2025
---
Source: [NPI Profile](https://npiprofile.com/npi/1326807462) · Data from the CMS NPPES public registry.