Provider Demographics
NPI:1972158889
Name:KENNEDY J SBAT DO FCCP LLC
Entity Type:Organization
Organization Name:KENNEDY J SBAT DO FCCP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNEDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SBAT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:484-645-6534
Mailing Address - Street 1:1569 MEDICAL DR STE 203
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3223
Mailing Address - Country:US
Mailing Address - Phone:484-645-6534
Mailing Address - Fax:484-945-0572
Practice Address - Street 1:1569 MEDICAL DR STE 203
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3223
Practice Address - Country:US
Practice Address - Phone:484-645-6534
Practice Address - Fax:484-752-4071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty