NPIMap

Organization Active NPI

Kennedy Medical Group Practice, P.C.

Doing business as d/b/a/ Kennedy Health Alliance

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Sicklerville, NJ
National Provider Identifier
1255743357
Registry record updated May 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
25MB03854300 Issued in NJ
Legal business name
KENNEDY MEDICAL GROUP PRACTICE, P.C.
Doing business as
d/b/a/ Kennedy Health Alliance
Practice address
524 Williamstown Road
Sicklerville, NJ 08081
Phone
(856) 772-9600
Fax
(856) 772-9650
NPI assigned
May 22, 2014
Last updated
May 22, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
KENNEDY MEDICAL GROUP PRACTICE, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 22, 2014

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

Authorized official

Name
Katherine Schleider
Title
Vpclinical Integration & Population
Phone
(856) 783-1987

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 25MB03854300 NJ Primary

Addresses

Primary practice location

524 Williamstown Road
Sicklerville, NJ 08081

Mailing address

205 E. Laurel Road
2ND Floor
Stratford, NJ 08084
Phone (856) 783-1987

Other identifiers 2

IdentifierTypeStateIssuer
3911101MedicaidNJ
P00633440OtherNJRAILROAD MEDICARE

Other names 1

  • d/b/a/ 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
Part of
Kennedy Medical Group Practice PC Dba Kennedy Health Alliance

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": "1400716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400716800000",
    "number": "1255743357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 E. LAUREL ROAD",
            "address_2": "2ND FLOOR",
            "city": "STRATFORD",
            "state": "NJ",
            "postal_code": "08084",
            "telephone_number": "856-783-1987",
            "fax_number": "856-783-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 WILLIAMSTOWN ROAD",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "08081",
            "telephone_number": "856-772-9600",
            "fax_number": "856-772-9650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY MEDICAL GROUP PRACTICE, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENNEDY MEDICAL GROUP PRACTICE, P.C.",
        "enumeration_date": "2014-05-22",
        "last_updated": "2014-05-22",
        "status": "A",
        "authorized_official_last_name": "SCHLEIDER",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_title_or_position": "VPCLINICAL INTEGRATION & POPULATION",
        "authorized_official_telephone_number": "856-783-1987"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NJ",
            "license": "25MB03854300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3911101",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00633440",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "d/b/a/ Kennedy Health Alliance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sicklerville, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2014; 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.