Provider Demographics
NPI:1568902146
Name:KENNEDY UNIVERSITY HOSPITAL, INC
Entity Type:Organization
Organization Name:KENNEDY UNIVERSITY HOSPITAL, INC
Other - Org Name:KENNEDY FAMILY HEALTH SERVICES PODIATRIST GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:CORPORATE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NESMITH-CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-309-7721
Mailing Address - Street 1:1 SOMERDALE SQ
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-1345
Mailing Address - Country:US
Mailing Address - Phone:856-309-7700
Mailing Address - Fax:856-566-8944
Practice Address - Street 1:1 SOMERDALE SQ
Practice Address - Street 2:
Practice Address - City:SOMERDALE
Practice Address - State:NJ
Practice Address - Zip Code:08083-1345
Practice Address - Country:US
Practice Address - Phone:856-309-7700
Practice Address - Fax:856-566-8944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty