NPIMap

Organization Active NPI

Kennedy Medical Group Practice P.C.

Doing business as Kennedy Health Alliance

  • Surgery Physician
  • Cherry Hill, NJ
National Provider Identifier
1225559495
Registry record updated Jun 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
KENNEDY MEDICAL GROUP PRACTICE P.C.
Doing business as
Kennedy health Alliance
Practice address
2211 Chapel Avenue West
Suite 301
Cherry Hill, NJ 08002
Phone
(856) 665-2017
Fax
(856) 488-6769
NPI assigned
Jun 28, 2017
Last updated
Jun 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Carman A Ciervo, D.O.
Title
Exp/Cpe
Phone
(856) 344-7360

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X NU
Internal Medicine Physician 207R00000X NU
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

2211 Chapel Avenue West
Suite 301
Cherry Hill, NJ 08002

Mailing address

205 E Laurel Rd
Stratford, NJ 08084-1301

Other identifiers 1

IdentifierTypeStateIssuer
0411248MedicaidNJ

Other names 1

  • Kennedy health Alliance Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kennedy Medical Group Practice PC Dba Kennedy Health Alliance36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498608000000",
    "number": "1225559495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 E LAUREL RD",
            "city": "STRATFORD",
            "state": "NJ",
            "postal_code": "080841301",
            "fax_number": "856-344-2315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 CHAPEL AVENUE WEST",
            "address_2": "SUITE 301",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "08002",
            "telephone_number": "856-665-2017",
            "fax_number": "856-488-6769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY MEDICAL GROUP PRACTICE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-28",
        "last_updated": "2017-06-28",
        "status": "A",
        "authorized_official_last_name": "CIERVO",
        "authorized_official_first_name": "CARMAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXP/CPE",
        "authorized_official_telephone_number": "856-344-7360",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0411248",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kennedy Health Alliance",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kennedy health Alliance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cherry Hill, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.