Healthcare Provider Details

I. General information

NPI: 1174663470
Provider Name (Legal Business Name): KENNEDY MEDICAL GROUP PRACTICE, P.C. D/B/A KENNEDY HEALTH ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 05/28/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E LAUREL RD
STRATFORD NJ
08084-1322
US

IV. Provider business mailing address

333 LAUREL OAK RD
VOORHEES NJ
08043-4453
US

V. Phone/Fax

Practice location:
  • Phone: 856-783-2244
  • Fax: 856-783-8537
Mailing address:
  • Phone: 856-783-2244
  • Fax: 856-783-8537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHERINE SCHLEIDER
Title or Position: VP CLINICAL INTEGRATION
Credential:
Phone: 856-344-7360