Provider Demographics
NPI:1992020358
Name:KENNEDY UNIVERSITY HOSPITAL, INC
Entity Type:Organization
Organization Name:KENNEDY UNIVERSITY HOSPITAL, INC
Other - Org Name:KENNEDY THORACIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-218-5710
Mailing Address - Street 1:900 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2358
Mailing Address - Country:US
Mailing Address - Phone:856-218-5740
Mailing Address - Fax:856-218-5749
Practice Address - Street 1:900 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2358
Practice Address - Country:US
Practice Address - Phone:856-218-5740
Practice Address - Fax:856-218-5749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6843301Medicaid
NJ6843301Medicaid