Healthcare Provider Details

I. General information

NPI: 1174869150
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: 12/20/2012
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LAUREL OAK RD SUITE D1
VOORHEES NJ
08043-3512
US

IV. Provider business mailing address

1001 LAUREL OAK RD SUITE D1
VOORHEES NJ
08043-3512
US

V. Phone/Fax

Practice location:
  • Phone: 856-783-0191
  • Fax: 856-783-0264
Mailing address:
  • Phone: 856-783-0191
  • Fax: 856-783-0264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHERINE SCHLEIDER
Title or Position: CORPORATE DIRECTOR
Credential:
Phone: 856-783-1987