NPIMap

Organization Active NPI

Kennedy Medical Group Practice P.C. D/B/a Kennedy Health Alliance

  • Pulmonary Disease Physician
  • Sewell, NJ
National Provider Identifier
1790215218
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
KENNEDY MEDICAL GROUP PRACTICE P.C. D/B/A KENNEDY HEALTH ALLIANCE
Practice address
900 Medical Center Dr Ste 205
Sewell, NJ 08080-2358
Phone
(844) 542-2273
NPI assigned
Jun 18, 2017
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X Primary

Addresses

Primary practice location

900 Medical Center Dr Ste 205
Sewell, NJ 08080-2358

Mailing address

205 E Laurel Rd
Stratford, NJ 08084-1301

Other identifiers 1

IdentifierTypeStateIssuer
0411248MedicaidNJ

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": "1497744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1790215218",
    "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": "900 MEDICAL CENTER DR STE 205",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080802358",
            "telephone_number": "844-542-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY MEDICAL GROUP PRACTICE P.C. D/B/A KENNEDY HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-18",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "CIERVO",
        "authorized_official_first_name": "CARMAN",
        "authorized_official_title_or_position": "EVP/CPE",
        "authorized_official_telephone_number": "856-344-7360"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0411248",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sewell, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.