Individual provider Active NPI

Suraj Depani

  • Physician Assistant
  • Cherry Hill, NJ
National Provider Identifier
1558242859
Registry record updated Feb 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00972100 Issued in NJ
Practice address
2201 Chapel Ave W
Cherry Hill, NJ 08002-2048
Phone
(856) 328-7890
NPI assigned
Sep 11, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 25MP00972100 NJ Primary

Addresses

Primary practice location

2201 Chapel Ave W
Cherry Hill, NJ 08002-2048

Mailing address

34 Bridle CT
Cherry Hill, NJ 08003-5154

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251219000127 NJ Practitioner - Physician Assistant 4082109897 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2201 Chapel Ave W
Cherry Hill, NJ 08002-2048
Phone (856) 513-4124

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
25MP00972100NJMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy Medical Group Practice PC CurrentSince Jan 5, 2026 Accepting new patients
Kennedy Medical Group Practice, P.C. CurrentSince Jan 5, 2026 Accepting new patients

Locations

2201 Chapel Ave W
Cherry Hill, NJ 08002
Phone (856) 488-6500

457 Haddonfield Rd
Ste 110
Cherry Hill, NJ 08002
Phone (856) 406-4091

18 E Laurel Rd
Stratford, NJ 08084
Phone (856) 346-6000

151 Fries Mill Rd
Ste 301
Turnersville, NJ 08012
Phone (856) 374-1881

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1757548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769904000000",
    "number": "1558242859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 BRIDLE CT",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080035154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 CHAPEL AVE W",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080022048",
            "telephone_number": "856-328-7890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEPANI",
        "first_name": "SURAJ",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-09-11",
        "last_updated": "2026-02-01",
        "certification_date": "2026-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00972100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cherry Hill, NJ

Sources for this page

Verify at the official NPI Registry.