Provider Demographics
NPI:1124398904
Name:KENNEDY MEDICAL GROUP
Entity Type:Organization
Organization Name:KENNEDY MEDICAL GROUP
Other - Org Name:KENNEDY HEALTH ALLIANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PHYSICIAN INTEGRATION
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-783-1892
Mailing Address - Street 1:545 BECKETT RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1547
Mailing Address - Country:US
Mailing Address - Phone:856-467-9634
Mailing Address - Fax:
Practice Address - Street 1:545 BECKETT RD
Practice Address - Street 2:SUITE 206
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1547
Practice Address - Country:US
Practice Address - Phone:856-467-9634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNEDY MEMORIAL HOSPITAL UNIVERSITY MEDICAL CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06994600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty