NPIMap

Organization Active NPI

Kennedy Medical Group Practice P.C.

Doing business as Kennedy Health Alliance

  • Infectious Disease Physician
  • Voorhees, NJ
National Provider Identifier
1326065087
Registry record updated Mar 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
KENNEDY MEDICAL GROUP PRACTICE P.C.
Doing business as
Kennedy Health Alliance
Practice address
709 Haddonfield Berlin Rd
Voorhees, NJ 08043-3714
Phone
(856) 566-3190
Fax
(856) 566-1903
NPI assigned
Jul 17, 2006
Last updated
Mar 1, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2017

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X NJ Primary

Addresses

Primary practice location

709 Haddonfield Berlin Rd
Voorhees, NJ 08043-3714

Mailing address

709 Haddonfield Berlin Rd
Voorhees, NJ 08043-3714
Phone (856) 566-3190

Other identifiers 3

IdentifierTypeStateIssuer
0411248MedicaidNJ
CA2405OtherNJRAILROAD MEDICARE
6270204MedicaidNJ

Other names 1

  • Kennedy Health Alliance Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kennedy Med GRP Prac PC36 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

Locations

709 Haddonfield Berlin Rd
Voorhees, NJ 08043
Phone (856) 566-3190

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488326400000",
    "number": "1326065087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 HADDONFIELD BERLIN RD",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080433714",
            "telephone_number": "856-566-3190",
            "fax_number": "856-566-1903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 HADDONFIELD BERLIN RD",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080433714",
            "telephone_number": "856-566-3190",
            "fax_number": "856-566-1903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY MEDICAL GROUP PRACTICE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2017-03-01",
        "status": "A",
        "authorized_official_last_name": "CIERVO",
        "authorized_official_first_name": "CARMAN",
        "authorized_official_title_or_position": "CPE",
        "authorized_official_telephone_number": "856-344-7360",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0411248",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA2405",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6270204",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kennedy Health Alliance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Voorhees, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 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.