Healthcare Provider Details

I. General information

NPI: 1811327638
Provider Name (Legal Business Name): KENNEDY MEDICAL GROUP D/B/A KENNEDY HEALTH ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1A REGULUS DRIVE
TURNERSVILLE NJ
08012
US

IV. Provider business mailing address

1A REGULUS DRIVE
TURNERSVILLE NJ
08012
US

V. Phone/Fax

Practice location:
  • Phone: 856-256-7513
  • Fax:
Mailing address:
  • Phone: 856-256-7513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE SCHLEIDER
Title or Position: VICE PRESIDENT - CLINICAL INTEGRATI
Credential:
Phone: 856-783-1892