Healthcare Provider Details

I. General information

NPI: 1851771117
Provider Name (Legal Business Name): KENNEDY UNIVERSITY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 FRIES MILL RD SUITE N-1
TURNERSVILLE NJ
08012-2015
US

IV. Provider business mailing address

1 SOMERDALE SQ
SOMERDALE NJ
08083-1345
US

V. Phone/Fax

Practice location:
  • Phone: 856-875-0505
  • Fax:
Mailing address:
  • Phone: 856-309-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: FELICIA NESMITH-CUNNINGHAM
Title or Position: CORPORATE DIRECTOR
Credential:
Phone: 856-309-7726