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General NPI Number Information
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NPI Number | 1952769994
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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 | 02/05/2016
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 188 FRIES MILL RD BLDG. N1
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-2015
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Country | US
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Telephone | 856-783-1987
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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 | 856-783-1987
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Fax |
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Authorized Official
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Title or Position | VP
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Name | KATHERINE SCHLEIDER
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Credential |
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Telephone | 856-783-1987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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