KENNEDY MEDICAL GROUP PRACTICE P.C. (NPI# 1225559495) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225559495 |
| Entity Type | Organization |
| Organization Name | KENNEDY MEDICAL GROUP PRACTICE P.C. |
| Other Organization Name | KENNEDY HEALTH ALLIANCE |
| Practice Address |
2211 Chapel Avenue West Suite 301 Cherry Hill NJ 08002 |
| Mailing Address |
205 E Laurel Rd Stratford NJ 08084-1301 |
| Practice Telephone | 8566652017 |
| Practice Fax Number | 8564886769 |
| Mailing Fax Number | 8563442315 |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2017-06-28 |
| Authorized Official Name | DR. CARMAN A CIERVO (EXP/CPE) |
| Authorized Official Telephone | 8563447360 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 133V00000X | Dietitian, Registered | Dietary & Nutritional Service Providers | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | 0411248 | 05 |
| Other Name | Type Code |
|---|---|
| Kennedy Health Alliance | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881138154 | Kennedy Medical Group Practice P.C. | Family Medicine | 630 B South White Horse Pike, Hammonton, NJ 08037 | 2016-12-06 |
| 1881987337 | Kennedy Medical Group Practice P.C. | Internal Medicine | 1 A Regulus Drive, Turnersville, NJ 08012 | 2011-05-17 |
| 1568996098 | Kennedy Medical Group Practice P.C. | Internal Medicine | 151 Fries Mill Rd, Suite 301, Turnersville, NJ 08012-2016 | 2017-04-11 |
| 1497295109 | Kennedy Medical Group Practice P.C. | Psychologist | 900 Route 168, Suite C#3, Blackwood, NJ 08012-3233 | 2017-02-28 |
| 1598203267 | Kennedy Medical Group Practice P.C. | Internal Medicine | 151 Fries Mill Rd, Suite 100, Turnersville, NJ 08012-2016 | 2017-02-02 |
| 1871039180 | Kennedy Medical Group Practice P.C. | Family Medicine | 100 Black Horse Pike, Audubon, NJ 08106-1950 | 2017-01-10 |
| 1942746367 | Kennedy Medical Group Practice P.C. | Family Medicine | 159 S Broad St, Woodbury, NJ 08096-2410 | 2017-01-09 |
| 1437693421 | Kennedy Medical Group Practice P.C. | Psychiatry & Neurology | 1305 Kings Hwy N, N#4, Cherry Hill, NJ 08034-1919 | 2016-12-09 |
| 1023374766 | Kennedy Medical Group Practice P.C. | Internal Medicine | 1300 Liberty Pl, Sicklerville, NJ 08081-5710 | 2012-04-06 |
| 1952615981 | Kennedy Medical Group Practice P.C. | Family Medicine | 165 Princeton Ave, West Deptford, West Deptford, NJ 08096-3123 | 2010-08-02 |
| Street Address |
2211 CHAPEL AVENUE WEST SUITE 301 |
| City | CHERRY HILL |
| State | NJ |
| Zip Code | 08002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649878547 | Rachel J Crutchley | Behavioral Analyst | 923 Haddonfield Road Suite 300, Cherry Hill, NJ 08002 | 2020-10-13 |
| 1356954713 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 650 Garden Park Blvd, Cherry Hill, NJ 08002 | 2020-08-26 |
| 1104483825 | Advocare, LLC | Specialist | 600 West Marlton Pike, Suite C, Cherry Hill, NJ 08002 | 2019-05-29 |
| 1881155299 | Tyesha Thomas | Counselor | 57 Colwick Drive, Suite 120, Cherry Hill, NJ 08002 | 2019-03-28 |
| 1982184479 | Brian Keith Smalls Jr. | Early Intervention Provider Agency | 1701 Bishop View Circle, Cherry Hill, NJ 08002 | 2018-08-15 |
| 1124510094 | Salvatore Montana Messina | Student in an Organized Health Care Education/Training Program | 2250 Chapel Avenue, Suite 100, Cherry Hill, NJ 08002 | 2018-06-05 |
| 1871010397 | Jocelyn Lea Daigle | Counselor | 2201 Chapel Avenue W, Cherry Hill, NJ 08002 | 2017-08-25 |
| 1245750926 | Casey Rich | Behavioral Analyst | 923 Haddonfield Rd Ste 300, Cherry Hill, NJ 08002 | 2017-06-22 |
| 1790211514 | Bancroft Neurohealth | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 11 Nevada Ave, Cherry Hill, NJ 08002 | 2017-05-11 |
| 1265968085 | Bancroft Neurohealth | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 600 Hanover Ave, Cherry Hill, NJ 08002 | 2017-05-11 |
| Find all providers in zip 08002 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| 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 |
|---|---|---|---|---|
| 1063775864 | Thaer Obaid | Surgery | 2211 Chapel Ave W Ste 301, Cherry Hill, NJ 08002-2062 | 2012-06-18 |
| 1124357686 | David Soowal | Surgery | 1600 Plymouth Rock Dr, Cherry Hill, NJ 08003-2748 | 2009-12-12 |
| 1790970804 | Frederick G. Meoli | Surgery | 87 Harrowgate Dr, Cherry Hill, NJ 08003-1939 | 2007-09-11 |
| 1619926946 | Surgical Group of South Jersey, P.a. | Surgery | 1935 Route 70 E, Cherry Hill, NJ 08003-2117 | 2006-05-05 |
| 1821063488 | Amrit P Nayar | Surgery | 1245 Brace Rd, Cherry Hill, NJ 08034 | 2006-02-17 |
| 1477554780 | Keith Meslin | Surgery | 1935 Route 70 East, Cherry Hill, NJ 08003 | 2005-08-09 |
| 1073962353 | Clinical Health Care Associates of New Jersey, PC | Surgery | 1865 Marlton Pike E, 2nd Floor Gi Surgery, Cherry Hill, NJ 08003-2013 | 2016-06-08 |
| 1396173431 | Advocare, LLC | Surgery | 2201 Chapel Ave W, Ste 100, Cherry Hill, NJ 08002-2048 | 2013-10-29 |
| 1124318332 | James Lee Crawford | Surgery | 401 Kings Hwy S Ste 5, Cherry Hill, NJ 08034-2500 | 2011-04-10 |
| 1528297678 | Adeshola Fakulujo | Surgery | 2201 Chapel Ave W, Suite 100, Cherry Hill, NJ 08002-2048 | 2009-07-10 |
| Find all providers in CHERRY HILL | ||||
| City | CHERRY HILL |
| Zip Code | 08002 |
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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.