Organization
KENNEDY MEDICAL GROUP PRACTICE P.C.
Active
Other names
Kennedy Health Alliance
Organization subpart
No
Provider details
NPI number
Authorized official
CARMAN CIERVO D.O. (CPE)
(856) 344-7360
Entity
Organization
Contact information
Practice address
100 BLACK HORSE PIKE, AUDUBON, NJ 08106-1950
(844) 542-2273
Mailing address
205 E LAUREL RD, STRATFORD, NJ 08084-1301
(856) 344-7360
(856) 344-2315
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041128
—
NJ
Enumeration date
01/10/2017
Last updated
01/10/2017
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