Provider Demographics
NPI:1760537930
Name:KENNEDY WOUND CARE CENTER
Entity Type:Organization
Organization Name:KENNEDY WOUND CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING HYPERBARIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-256-2063
Mailing Address - Street 1:543 EGG HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2335
Mailing Address - Country:US
Mailing Address - Phone:856-256-2063
Mailing Address - Fax:856-256-2064
Practice Address - Street 1:33 CASTLETON LN
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3049
Practice Address - Country:US
Practice Address - Phone:856-638-0108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB05205500261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ362000Medicaid
NJE62055Medicare UPIN