Healthcare Provider Details

I. General information

NPI: 1629187125
Provider Name (Legal Business Name): KENNEDY SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 EGG HARBOR RD
SEWELL NJ
08080-2336
US

IV. Provider business mailing address

PO BOX 48023
NEWARK NJ
07101-4823
US

V. Phone/Fax

Practice location:
  • Phone: 856-218-4900
  • Fax: 856-256-1276
Mailing address:
  • Phone: 856-661-5164
  • Fax: 856-661-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number82444
License Number StateNJ

VIII. Authorized Official

Name: MR. JOSEPH LARIO
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 856-661-5144