KENNEDY MEDICAL GROUP PRACTICE, P.C. (NPI# 1073884847) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073884847 |
| Entity Type | Organization |
| Organization Name | KENNEDY MEDICAL GROUP PRACTICE, P.C. |
| Other Organization Name | KENNEDY HEALTH ALLIANCE |
| Practice Address |
333 Laurel Oak Rd Voorhees NJ 08043-4453 |
| Practice Telephone | 8567830191 |
| Practice Fax Number | 8567830264 |
| Mailing Telephone | 8567830191 |
| Mailing Fax Number | 8567830264 |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2015-10-13 |
| Authorized Official Name | KATHY SCHLEIDER (VP CLINICAL INTEGRATION) |
| Authorized Official Telephone | 8563447360 |
| Is Organization Subpart | Y |
| Parent Organization Name | KENNEDY MEMORIAL HOSPITAL UNIVERSITY MEDICAL CENTER INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
25MA09025500 | NJ | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Kennedy Health Alliance | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669847646 | Kennedy Medical Group Practice, P.C. | Internal Medicine | 2211 Chapel Ave West, Ste 301, Cherry Hill, NJ 08002 | 2015-12-02 |
| 1578975520 | Kennedy Medical Group Practice, P.C. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 485 Williamstown Road, Sicklerville, NJ 08081 | 2014-05-27 |
| 1629343421 | Kennedy Medical Group Practice, P.C. | Surgery | 543 Egg Harbor Road, Sewell, NJ 08080-2335 | 2012-03-13 |
| 1558727677 | Kennedy Medical Group Practice, P.C. | Surgery | 333 Laurel Oak Rd, Voorhees, NJ 08043-4453 | 2016-01-05 |
| 1346615333 | Kennedy Medical Group Practice, P.C. | Internal Medicine | 457 Haddonfield Rd, Ste. 110, Cherry Hill, NJ 08002-2220 | 2015-12-02 |
| 1902271992 | Kennedy Medical Group Practice, P.C. | Surgery | 668 Main St, Ste. 4, Lumberton, NJ 08048-5016 | 2015-12-02 |
| 1003281080 | Kennedy Medical Group Practice, P.C. | Surgery | 570 Egg Harbor Rd, Suite C-2, Sewell, NJ 08080-2359 | 2015-12-02 |
| 1932511987 | Kennedy Medical Group Practice, P.C. | Obstetrics & Gynecology | 188 Fries Mill Rd, Suite N3, Blackwood, NJ 08012-2015 | 2014-05-27 |
| 1164834297 | Kennedy Medical Group Practice, P.C. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2301 Evesham Road, Suite 406, Voorhees, NJ 08043 | 2014-05-23 |
| 1255743357 | Kennedy Medical Group Practice, P.C. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 524 Williamstown Road, Sicklerville, NJ 08081 | 2014-05-22 |
| Street Address |
333 LAUREL OAK RD |
| City | VOORHEES |
| State | NJ |
| Zip Code | 08043-4453 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649276320 | David Zalut | Family Medicine | 333 Laurel Oak Rd, Voorhees, NJ 08043-4453 | 2005-06-27 |
| 1225676661 | Clarissa A Monckton | Nurse Practitioner | 333 Laurel Oak Rd, Voorhees, NJ 08043-4453 | 2019-12-17 |
| 1518458801 | Maria Nicodemo | Social Worker | 333 Laurel Oak Rd, Voorhees, NJ 08043 | 2018-05-23 |
| 1083154942 | Manoucheka Emmanuel | Social Worker | 333 Laurel Oak Rd, Voorhees, NJ 08043 | 2017-02-27 |
| 1558727677 | Kennedy Medical Group Practice, P.C. | Surgery | 333 Laurel Oak Rd, Voorhees, NJ 08043-4453 | 2016-01-05 |
| 1962867671 | Kennedy Medical Group Practice, PC | Internal Medicine | 333 Laurel Oak Rd, Voorhees, NJ 08043-4453 | 2015-12-22 |
| 1831562008 | Stephanie Ann Ferroni | Nurse Practitioner | 333 Laurel Oak Rd, Voorhees, NJ 08043-4453 | 2015-11-09 |
| 1952786337 | Kennedy Medical Group Practice, P.C. D/b/a Kennedy Health Alliance | Internal Medicine | 333 Laurel Oak Rd, Voorhees, NJ 08043-4453 | 2015-07-27 |
| 1356723084 | Vishal Phakey | Family Medicine | 333 Laurel Oak Rd, Voorhees, NJ 08043 | 2015-06-18 |
| 1952726796 | Kennedy Medical Group Practice, P.C. | Hospitalist | 333 Laurel Oak Rd, Voorhees, NJ 08043-4453 | 2014-03-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679186308 | Priya P Amin | Chiropractor | 1307 White Horse Road, Building B Suite 200, Voorhees, NJ 08043 | 2020-08-24 |
| 1184233207 | Creek Healthcare Services LLC | Community/Behavioral Health | 39 William Feather Drive, Voorhees Township, NJ 08043 | 2020-07-24 |
| 1689215345 | Julia Amariti | Dietitian, Registered | 2309 E Evesham Rd Ste 101b, Voorhees, NJ 08043 | 2019-10-03 |
| 1457821787 | Hcp Voorhees Township Nj Opco, LLC | Alzheimer Center (Dementia Center) | 1301 Laurel Oak Road, Voorhees Township, NJ 08043 | 2018-11-29 |
| 1003386665 | Durand, Inc. | In Home Supportive Care | 107 Camden Avenue, Voorhees, NJ 08043 | 2018-11-27 |
| 1285103663 | Samaritan Healthcare & Hospice, Inc. | Hospice, Inpatient | 265 Route 73 South, Voorhees, NJ 08043 | 2018-11-15 |
| 1184192734 | Michelle Ko | Physician Assistant | 900 Centennial Blvd Ste K, Voorhees, NJ 08043 | 2018-11-12 |
| 1346716107 | Ashlee Barton | Counselor | 1103 Sheppard Rd, Voorhees Township, NJ 08043 | 2018-10-19 |
| 1033691472 | Carolyn A Gribbin | Social Worker | 3033 5th Street, Voorhees, NJ 08043 | 2018-09-01 |
| 1164902193 | Paul Pierson | Physical Therapist | 1010 Haddonfield Berlin Rd Ste 401, Voorhees, NJ 08043 | 2018-08-20 |
| Find all providers in zip 08043 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639283344 | Charles L Dietzek | Surgery | 1101 White Horse Rd, Suite C, Voorhees, NJ 08043-2157 | 2006-08-18 |
| 1922448539 | Elias Fakhoury | Surgery | 333 Laurel Oak Rd, Voorhees, NJ 08043-4453 | 2013-06-27 |
| 1740428929 | Farouk Marzouk | Surgery | 1001 Laurel Oak Rd, Suite D1, Voorhees, NJ 08043-3512 | 2009-01-27 |
| 1720249121 | Susanna H Shin | Surgery | 333 Laurel Oak Rd, Voorhees, NJ 08043-4453 | 2008-06-19 |
| 1619179686 | Timothy Wu | Surgery | 333 Laurel Oak Rd, Voorhees, NJ 08043-4453 | 2007-06-01 |
| 1306905658 | Charles L Dietzek, Do, Facos, PC | Surgery | 1000 White Horse Rd, Suite 703, Voorhees, NJ 08043-4406 | 2006-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801447784 | Heritage Wound Care LLC | Surgery | 163 Madison Ave Ste 220, Morristown, NJ 07960-7325 | 2019-09-23 |
| 1063063188 | Jvg Cardiovascular LLC | Surgery | 60 Baldwin Rd Ste 101b, Parsippany, NJ 07054-2901 | 2019-09-20 |
| 1558918359 | Varicose Veins Doctor Pa | Surgery | 3478 Kennedy Blvd, Jersey City, NJ 07307-4117 | 2019-08-26 |
| 1437701729 | Usa Vascular Center of New Jersey LLC | Surgery | 272 Main St Ste A, Orange, NJ 07050-3605 | 2019-07-16 |
| 1396301974 | Vascular & Vein Center of New Jersey LLC | Surgery | 10 Industrial Way E Ste 103, Eatontown, NJ 07724-3332 | 2019-05-19 |
| 1568936326 | Heritage Vascular PC | Surgery | 663 E Crescent Ave Ste 111, Ramsey, NJ 07446-1220 | 2019-01-15 |
| 1144761685 | Center for Vascular Medicine Nj, LLC | Surgery | 415 Route 24 Ste 6/7, Chester, NJ 07930-2920 | 2017-03-16 |
| 1134665631 | Robert S.walsky Md | Surgery | 22 Angela Ct, Woodcliff Lake, NJ 07677-8102 | 2017-01-09 |
| 1982074290 | Frontier Medical Care | Surgery | 301 Tavistock, Cherry Hill, NJ 08034-4020 | 2015-09-29 |
| 1023486925 | Associates In Vascular Care LLC Limb Salvage Center | Surgery | 1000 Route 35 South, Suite 300, Middletown, NJ 07748-2606 | 2015-09-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.