Provider Demographics
NPI:1346579463
Name:KENNEDY MEMORIAL HOSPITALS - UNIVERSITY
Entity Type:Organization
Organization Name:KENNEDY MEMORIAL HOSPITALS - UNIVERSITY
Other - Org Name:KENNEDY UNIVERSITY HOSPITAL-STRATFORD DIVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-661-5350
Mailing Address - Street 1:500 MARLBORO AVE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2020
Mailing Address - Country:US
Mailing Address - Phone:856-661-5350
Mailing Address - Fax:856-661-5244
Practice Address - Street 1:18 E LAUREL RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1327
Practice Address - Country:US
Practice Address - Phone:856-346-7319
Practice Address - Fax:856-346-6476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-19
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS003972003336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3196602OtherNCPDP PROVIDER IDENTIFICATION NUMBER
310086Medicare Oscar/Certification