Healthcare Provider Details

I. General information

NPI: 1740213461
Provider Name (Legal Business Name): KENNEDY MEDICAL GROUP PRACTICE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N MAIN ST
GLASSBORO NJ
08028-1637
US

IV. Provider business mailing address

333 LAUREL OAK RD
VOORHEES NJ
08043-4453
US

V. Phone/Fax

Practice location:
  • Phone: 844-542-2273
  • Fax:
Mailing address:
  • Phone: 856-344-7360
  • Fax: 856-783-1403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GREG TAYLOR
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 856-344-7360