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General NPI Number Information
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NPI Number | 1174663470
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Entity Type | Organization
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Legal Business Name | KENNEDY MEDICAL GROUP PRACTICE, P.C. D/B/A KENNEDY HEALTH ALLIANCE
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 25 E LAUREL RD
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City | STRATFORD
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State | NJ
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Zip | 08084-1322
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Country | US
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Telephone | 856-783-2244
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Fax | 856-783-8537
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Provider Business Mailing Address
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Address Line | 333 LAUREL OAK RD
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City | VOORHEES
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State | NJ
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Zip | 08043-4453
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Country | US
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Telephone | 856-783-2244
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Fax | 856-783-8537
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Authorized Official
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Title or Position | VP CLINICAL INTEGRATION
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Name | MRS. KATHERINE SCHLEIDER
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Credential |
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Telephone | 856-344-7360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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