NPIMap

Organization Active NPI

Kennedy Medical Group Practice, P.C.

  • Surgery Physician
  • Cherry Hill, NJ
National Provider Identifier
1669847646
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
KENNEDY MEDICAL GROUP PRACTICE, P.C.
Practice address
2211 Chapel Ave West
Ste 301
Cherry Hill, NJ 08002
Phone
(856) 665-2017
Fax
(856) 488-6769
NPI assigned
Dec 2, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Carman Ciervo
Title
Cpe
Phone
(856) 344-7360

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

2211 Chapel Ave West
Ste 301
Cherry Hill, NJ 08002

Mailing address

333 Laurel Oak Rd
Voorhees, NJ 08043-4453
Phone (856) 783-1987

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": "1449014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1669847646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 LAUREL OAK RD",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080434453",
            "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": "2211 CHAPEL AVE WEST",
            "address_2": "STE 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": "2015-12-02",
        "last_updated": "2022-07-21",
        "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"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "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"
        }
    ]
}

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 Jul 21, 2022; 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.