NPIMap

Organization Active NPI

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

  • Family Medicine Physician
  • Sicklerville, NJ
National Provider Identifier
1902217607
Registry record updated Aug 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
26NJ00504300 Issued in NJ
Legal business name
KENNEDY MEDICAL GROUP PRACTICE, P.C. D/B/A KENNEDY HEALTH ALLIANCE
Practice address
1300 Liberty PL
Sicklerville, NJ 08081-5710
Phone
(856) 262-8100
NPI assigned
May 15, 2014
Last updated
Aug 18, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2014

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

Authorized official

Name
Amanda Marie Fox, FNP-C
Title
NP
Phone
(856) 262-8100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 26NJ00504300 NJ Primary

Addresses

Primary practice location

1300 Liberty PL
Sicklerville, NJ 08081-5710

Mailing address

1300 Liberty PL
Sicklerville, NJ 08081-5710
Phone (856) 262-8100

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": "1400112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408320000000",
    "number": "1902217607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 LIBERTY PL",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080815710",
            "telephone_number": "856-262-8100",
            "fax_number": "856-885-6859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 LIBERTY PL",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080815710",
            "telephone_number": "856-262-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY MEDICAL GROUP PRACTICE, P.C. D/B/A KENNEDY HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-15",
        "last_updated": "2014-08-18",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "NP",
        "authorized_official_telephone_number": "856-262-8100",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "26NJ00504300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sicklerville, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2014; 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.