# 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:** 1942746367
- **Authorized official:** CARMAN A CIERVO D.O. (CPE)
- **Authorized official phone:** (856) 344-7360

## Contact information

- **Practice address:** 159 S BROAD ST, WOODBURY, NJ 08096-2410
- **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 |
| 207RG0100X | Gastroenterology Physician | — | NULL | — |
| 207RG0100X | Gastroenterology Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | — |
| 2086S0129X | Vascular Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 01/09/2017
- **Last updated:** 10/19/2017