NPIMap

Organization Active NPI

Kennedy Medical Group Practice, PC

  • Neurology Physician
  • Turnersville, NJ
National Provider Identifier
1982069688
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
KENNEDY MEDICAL GROUP PRACTICE, PC
Practice address
151 Fries Mill Rd Ste 102
Turnersville, NJ 08012-2056
Phone
(856) 352-6660
Fax
(856) 269-4258
NPI assigned
Dec 22, 2015
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Carman A Ciervo, DO
Title
Ceo
Phone
(856) 783-1987

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X Primary

Addresses

Primary practice location

151 Fries Mill Rd Ste 102
Turnersville, NJ 08012-2056

Mailing address

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

Other practice location 1

73 N Maple Ave
Ste. B
Marlton, NJ 08053-1782
Phone (856) 783-1987

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": "1450742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1982069688",
    "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": "151 FRIES MILL RD STE 102",
            "city": "TURNERSVILLE",
            "state": "NJ",
            "postal_code": "080122056",
            "telephone_number": "856-352-6660",
            "fax_number": "856-269-4258"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "73 N Maple Ave",
            "address_2": "Ste. B",
            "address_purpose": "LOCATION",
            "city": "Marlton",
            "state": "NJ",
            "postal_code": "080531782",
            "country_code": "US",
            "telephone_number": "856-783-1987",
            "fax_number": "856-783-1403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KENNEDY MEDICAL GROUP PRACTICE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-22",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "CIERVO",
        "authorized_official_first_name": "CARMAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "856-783-1987",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Turnersville, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.