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General NPI Number Information
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NPI Number | 1326065087
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Entity Type | Organization
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Legal Business Name | KENNEDY MEDICAL GROUP PRACTICE P.C.
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 709 HADDONFIELD BERLIN RD
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City | VOORHEES
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State | NJ
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Zip | 08043-3714
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Country | US
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Telephone | 856-566-3190
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Fax | 856-566-1903
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Provider Business Mailing Address
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Address Line | 709 HADDONFIELD BERLIN RD
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City | VOORHEES
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State | NJ
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Zip | 08043-3714
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Country | US
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Telephone | 856-566-3190
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Fax | 856-566-1903
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Authorized Official
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Title or Position | CPE
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Name | CARMAN CIERVO
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Credential | D.O.
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State | NJ
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