NPIMap

Organization Active NPI

Kennedy Medical Group Practice P.C.

Doing business as Kennedy Health Alliance

  • Obstetrics & Gynecology Physician
  • Hammonton, NJ
National Provider Identifier
1881138154
Registry record updated Dec 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
KENNEDY MEDICAL GROUP PRACTICE P.C.
Doing business as
Kennedy Health Alliance
Practice address
630 B South White Horse Pike
Hammonton, NJ 08037
Phone
(844) 542-2273
NPI assigned
Dec 6, 2016
Last updated
Dec 6, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2016

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

Authorized official

Name
Carman Ciervo, D.O.
Title
Chief Physician Executive
Phone
(856) 344-7360

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU
Obstetrics & Gynecology Physician 207V00000X NU Primary

Addresses

Primary practice location

630 B South White Horse Pike
Hammonton, NJ 08037

Mailing address

205 E Laurel Rd
Stratford, NJ 08084-1301
Phone (856) 344-7360

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

Locations

630 S White Horse Pike
#B
Hammonton, NJ 08037
Phone (609) 200-0353

NPI Registry JSON

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

{
    "created_epoch": "1480982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480982400000",
    "number": "1881138154",
    "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",
            "telephone_number": "856-344-7360",
            "fax_number": "856-344-2315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 B SOUTH WHITE HORSE PIKE",
            "city": "HAMMONTON",
            "state": "NJ",
            "postal_code": "08037",
            "telephone_number": "844-542-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY MEDICAL GROUP PRACTICE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-06",
        "last_updated": "2016-12-06",
        "status": "A",
        "authorized_official_last_name": "CIERVO",
        "authorized_official_first_name": "CARMAN",
        "authorized_official_title_or_position": "CHIEF PHYSICIAN EXECUTIVE",
        "authorized_official_telephone_number": "856-344-7360",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "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 Hammonton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2016; 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.