Organization
KENNEDY MEDICAL GROUP PRACTICE, P.C.
Active
Parent organization
KENNEDY MEDICAL GROUP PRACTICE, P.C.
Other names
d/b/a/ Kennedy Health Alliance
Organization subpart
Yes
Provider details
NPI number
Legal business name
KENNEDY MEDICAL GROUP PRACTICE, P.C.
Authorized official
KATHERINE SCHLEIDER (VPCLINICAL INTEGRATION & POPULATION)
(856) 783-1987
Entity
Organization
Contact information
Practice address
524 WILLIAMSTOWN ROAD, SICKLERVILLE, NJ 08081
(856) 772-9600
(856) 772-9650
Mailing address
205 E. LAUREL ROAD, 2ND FLOOR, STRATFORD, NJ 08084
(856) 783-1987
(856) 783-1403
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
25MB03854300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3911101
—
NJ
01
—
P00633440
RAILROAD MEDICARE
NJ
Enumeration date
05/22/2014
Last updated
05/22/2014
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