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General NPI Number Information
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NPI Number | 1124398904
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Entity Type | Organization
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Legal Business Name | KENNEDY MEDICAL GROUP
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 545 BECKETT RD SUITE 206
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City | SWEDESBORO
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State | NJ
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Zip | 08085-1547
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Country | US
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Telephone | 856-467-9634
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Fax |
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Provider Business Mailing Address
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Address Line | 545 BECKETT RD SUITE 206
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City | SWEDESBORO
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State | NJ
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Zip | 08085-1547
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Country | US
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Telephone | 856-467-9634
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, PHYSICIAN INTEGRATION
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Name | KATHY SCHLEIDER
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Credential |
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Telephone | 856-783-1892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MB06994600
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License Number State | NJ
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