Organization
KENNEDY MEDICAL GROUP PRACTICE P.C. D/B/A KENNEDY HEALTH ALLIANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMAN CIERVO (EVP/CPE)
(856) 344-7360
Entity
Organization
Contact information
Practice address
900 MEDICAL CENTER DR STE 205, SEWELL, NJ 08080-2358
(844) 542-2273
Mailing address
205 E LAUREL RD, STRATFORD, NJ 08084-1301
(856) 344-2315
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0411248
—
NJ
Enumeration date
06/18/2017
Last updated
06/16/2018
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