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General NPI Number Information
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NPI Number | 1184761850
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Entity Type | Organization
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Legal Business Name | KENNEDY CARE CENTER,P.A.
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 705 WHITE HORSE RD SUITE D-102
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City | VOORHEES
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State | NJ
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Zip | 08043-2468
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Country | US
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Telephone | 856-783-0695
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Fax | 856-783-8083
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Provider Business Mailing Address
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Address Line | 705 WHITE HORSE RD SUITE D-102
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City | VOORHEES
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State | NJ
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Zip | 08043-2468
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Country | US
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Telephone | 856-783-0695
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Fax | 856-783-8083
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY LEITMAN
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Credential | D.O.
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Telephone | 856-783-0695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MB31922
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License Number State | NJ
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