Healthcare Provider Details

I. General information

NPI: 1154347367
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: 07/14/2006
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 FRIES MILL RD SUITE 400
TURNERSVILLE NJ
08012
US

IV. Provider business mailing address

151 FRIES MILL RD SUITE 400
TURNERSVILLE NJ
08012
US

V. Phone/Fax

Practice location:
  • Phone: 856-401-9300
  • Fax: 856-374-5805
Mailing address:
  • Phone: 856-401-9300
  • Fax: 856-374-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE O'NEIL
Title or Position: CREDENTIALING
Credential:
Phone: 856-783-1987