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General NPI Number Information
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NPI Number | 1598937617
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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 | 03/28/2008
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 565 EGG HARBOR RD
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City | SEWELL
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State | NJ
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Zip | 08080-2335
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Country | US
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Telephone | 856-256-0600
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Fax |
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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 | 856-344-7360
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Fax | 856-783-1403
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Authorized Official
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Title or Position | PHYSICIAN
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Name | GREG TAYLOR
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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