KENNEDY MEDICAL GROUP PRACTICE P.C. (NPI# 1942746367) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942746367 |
| Entity Type | Organization |
| Organization Name | KENNEDY MEDICAL GROUP PRACTICE P.C. |
| Other Organization Name | KENNEDY HEALTH ALLIANCE |
| Practice Address |
159 S Broad St Woodbury NJ 08096-2410 |
| Mailing Address |
205 E Laurel Rd Stratford NJ 08084-1301 |
| Practice Telephone | 8445422273 |
| Mailing Telephone | 8563447360 |
| Mailing Fax Number | 8563442315 |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2017-10-19 |
| Authorized Official Name | CARMAN A CIERVO (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 | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians | ||
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NH | 0411248 | 05 |
| Other Name | Type Code |
|---|---|
| Kennedy health Alliance | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225559495 | Kennedy Medical Group Practice P.C. | Dietitian, Registered | 2211 Chapel Avenue West, Suite 301, Cherry Hill, NJ 08002 | 2017-06-28 |
| 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 |
| 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 |
159 S BROAD ST |
| City | WOODBURY |
| State | NJ |
| Zip Code | 08096-2410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992746242 | Susan Tamagni | Physician Assistant | 159 S Broad St, Woodbury, NJ 08096-2410 | 2006-06-09 |
| 1710390364 | Priya Shah | Internal Medicine | 159 S Broad St, Woodbury, NJ 08096-2410 | 2014-06-10 |
| 1376863530 | Ifeoma M Akumuo | Pharmacist | 159 S Broad St, Woodbury, NJ 08096-2410 | 2010-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780226043 | Assoc. for Retarded Citizens, Inc. Gloucester County | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1460 Cooper Street, Deptford, NJ 08096 | 2019-10-08 |
| 1730652058 | Robert Crawford Counseling & Consultation, LLC | Counselor | Robert Crawford Counseling & Consultation, LLC, 44 Cooper Street, Suite 208, Woodbury, NJ 08096 | 2019-01-09 |
| 1902381171 | Services To Overcome Drug Abuse Among Teenagers, Inc. | Clinic/Center | 124 N Broad Street, Woodbury, NJ 08096 | 2018-10-03 |
| 1225518715 | Michael West | Pharmacist | 631 West Mantua Ave, Woodbury, NJ 08096 | 2018-08-15 |
| 1053807891 | Standing Ground Counseling, LLC | Clinic/Center | 44 Cooper Street, Suite 104, Woodbury, NJ 08096 | 2018-07-05 |
| 1376054536 | Assoc. for Retarded Citizens, Inc. Gloucester County | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 40 Hessian Avenue, Woodbury, NJ 08096 | 2017-10-16 |
| 1881105021 | Assoc. for Retarded Citizens, Inc. Gloucester County | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1154 Bennett Drive, Deptford, NJ 08096 | 2017-10-16 |
| 1215448469 | Assoc. for Retarded Citizens, Inc. Gloucester County | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7 North Evergreen Avenue, Woodbury, NJ 08096 | 2017-10-16 |
| 1801307137 | Assoc. for Retarded Citizens, Inc. Gloucester County | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 6 North Drexel Street, Woodbury, NJ 08096 | 2017-10-13 |
| 1295253847 | Sara Alven | Social Worker | 1 Lupton Avenue, Woodbury, NJ 08096 | 2017-09-05 |
| Find all providers in zip 08096 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811401128 | Pk Medical, Pllc | Internal Medicine | Excel At Woodbury, 8533 Jericho Turnpile, Woodbury, NY 11797-1804 | 2017-11-22 |
| 1962894089 | Soltani Medical PC | Internal Medicine | 11 Joyce Ct, Woodbury, NY 11797-2110 | 2015-02-26 |
| 1649600651 | Wei Yan Tan Physician. P.C. | Internal Medicine | 281 Syosset Woodbury Rd, Woodbury, NY 11797-1205 | 2013-11-13 |
| 1548602865 | Monica Bajracharya | Internal Medicine | 9373 Compass Pointe Rd, Woodbury, MN 55129 | 2013-07-28 |
| 1093079220 | Herbert Swarz | Internal Medicine | 20 Scuppo Rd, Woodbury, CT 06798-3811 | 2012-07-03 |
| 1366706723 | Zubin Arora | Internal Medicine | 237 Radio Dr #210, Woodbury, MN 55125-5805 | 2012-06-30 |
| 1184983272 | Fred Yale Lobovsky | Internal Medicine | 25 Lark Drive, Woodbury, NY 11797-3203 | 2012-05-09 |
| 1861763559 | Daniel Benjamin Goodman | Internal Medicine | 60 Davids Hill Rd, Woodbury, CT 06798-2113 | 2012-01-26 |
| 1912291873 | Tony George | Internal Medicine | 250 Plainview Rd, Woodbury, NY 11797-2807 | 2011-06-07 |
| 1073849444 | Ann Wendling | Internal Medicine | 6603 Crackleberry Trl, Woodbury, MN 55129-8404 | 2009-10-20 |
| Find all providers in WOODBURY | ||||
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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.