Organization
KENNEDY MEDICAL GROUP PRACTICE, P.C.
Active
Parent organization
KENNEDY HEALTH SYSTEM
Other names
Jefferson Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
KENNEDY HEALTH SYSTEM
Authorized official
RICARDO PEREZ (VP OF CLINICAL SERVICES)
(856) 218-5634
Entity
Organization
Contact information
Practice address
333 LAUREL OAK RD, VOORHEES, NJ 08043-4453
(856) 783-1987
Mailing address
PO BOX 824967, PHILADELPHIA, PA 19182-4967
(800) 941-8933
(732) 918-8940
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
2084N0400X
Neurology Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
208D00000X
General Practice Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
208M00000X
Hospitalist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0411248
—
NJ
Enumeration date
03/04/2014
Last updated
06/08/2021
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