KENNEDY MEDICAL GROUP PRACTICE, P.C. (NPI# 1629343421) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1629343421 |
Entity Type | Organization |
Organization Name | KENNEDY MEDICAL GROUP PRACTICE, P.C. |
Other Organization Name | KENNEDY HEALTH ALLIANCE |
Practice Address |
543 Egg Harbor Road Sewell NJ 08080-2335 |
Mailing Address |
205 E Laurel Rd 2nd Floor Stratford NJ 08084-1301 |
Practice Telephone | 8562562063 |
Practice Fax Number | 8562562064 |
Mailing Telephone | 8567831892 |
Mailing Fax Number | 8567831403 |
Enumeration Date | 2012-03-13 |
Last Update Date | 2014-06-18 |
Authorized Official Name | KATHERINE KATHERINE (VP CLINICAL INTEGRATION) |
Authorized Official Telephone | 8567831982 |
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 |
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 |
1952726796 | Kennedy Medical Group Practice, P.C. | Hospitalist | 333 Laurel Oak Rd, Voorhees, NJ 08043-4453 | 2014-03-04 |
Street Address |
543 EGG HARBOR ROAD |
City | SEWELL |
State | NJ |
Zip Code | 08080-2335 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1679180301 | Peter Ansong | Pharmacist | 500 Egg Harbor Road, Sewell, NJ 08080 | 2020-09-27 |
1477018752 | Shi-iii Washington Township LLC | Alzheimer Center (Dementia Center) | 339 Greentree Road, Washington Township, NJ 08080 | 2019-01-31 |
1245741495 | Assoc. for Retarded Citizens. Inc. Gloucester County | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1 Fawn Drive, Sewell, NJ 08080 | 2017-10-16 |
1851802029 | Assoc. for Retarded Citizens, Inc. Gloucester County | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 275 Greentree Road, Sewell, NJ 08080 | 2017-10-16 |
1598284770 | Bryan Hendricks | Psychologist | 123 Egg Harbor Rd., Suite 302, Sewell, NJ 08080 | 2017-09-19 |
1912426339 | Mary Faralli | Speech-Language Pathologist | 24 Upton Way, Sewell, NJ 08080 | 2017-09-18 |
1669990578 | Oaks Integrated Care | Clinic/Center | 322 Fishpond Rd, Sewell, NJ 08080 | 2017-08-31 |
1972032316 | Nutan K Ravani | Social Worker | 3 Heritage Valley Drive, Sewell, NJ 08080 | 2017-06-08 |
1447784038 | The Devereux Foundation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 224 West Warren Avenue, Sewell, NJ 08080 | 2017-04-20 |
1326572173 | The Devereux Foundation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 363 Ganttown Road, Turnersville, NJ 08080 | 2017-04-19 |
Find all providers in zip 08080 |
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 |
---|---|---|---|---|
1861545188 | Charles L. Dietzek | Surgery | 543 Egg Harbor Rd, Sewell, NJ 08080-2335 | 2007-01-19 |
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.