# KENNEDY MEDICAL GROUP PRACTICE P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kennedy Health Alliance
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871039180
- **Authorized official:** CARMAN CIERVO D.O. (CPE)
- **Authorized official phone:** (856) 344-7360

## Contact information

- **Practice address:** 100 BLACK HORSE PIKE, AUDUBON, NJ 08106-1950
- **Practice address phone:** (844) 542-2273
- **Mailing address:** 205 E LAUREL RD, STRATFORD, NJ 08084-1301
- **Mailing address phone:** (856) 344-7360
- **Mailing address fax:** (856) 344-2315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/10/2017
- **Last updated:** 01/10/2017