Healthcare Provider Details

I. General information

NPI: 1952786337
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: 07/27/2015
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LAUREL OAK RD
VOORHEES NJ
08043-4453
US

IV. Provider business mailing address

333 LAUREL OAK RD 1099 WHITE HORSE RD
VOORHEES NJ
08043-4453
US

V. Phone/Fax

Practice location:
  • Phone: 856-783-1987
  • Fax:
Mailing address:
  • Phone: 856-783-1987
  • 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 TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE SCHLEIDER
Title or Position: VP CLINICAL INTEGRATION
Credential:
Phone: 856-783-1987