# KENNEDY MEDICAL GROUP PRACTICE, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346615333
- **Authorized official:** CARMAN A CIERVO (CEO)
- **Authorized official phone:** (856) 783-1987

## Contact information

- **Practice address:** 457 HADDONFIELD RD, STE. 110, CHERRY HILL, NJ 08002-2220
- **Practice address phone:** (856) 783-1987
- **Practice address fax:** (856) 783-1403
- **Mailing address:** 333 LAUREL OAK RD, VOORHEES, NJ 08043-4453
- **Mailing address phone:** (856) 783-1987
- **Mailing address fax:** (856) 783-1403

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | — |
| 207RG0100X | Gastroenterology Physician | — | NULL | — |
| 207RG0100X | Gastroenterology Physician | — | — | — |
| 2084N0400X | Neurology Physician | — | NULL | — |
| 2084N0400X | Neurology Physician | — | — | — |

## Other

- **Enumeration date:** 12/02/2015
- **Last updated:** 10/19/2017