KENNEDY MEDICAL GROUP PRACTICE PC (NPI# 1952848905) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952848905 |
| Entity Type | Organization |
| Organization Name | KENNEDY MEDICAL GROUP PRACTICE PC |
| Other Organization Name | KENNEDY HEALTH ALLIANCE |
| Practice Address |
100 Kings Way E Suite D2 Sewell NJ 08080-2237 |
| Mailing Address |
1099 White Horse Rd Voorhees NJ 08043-4405 |
| Practice Telephone | 8562187730 |
| Practice Fax Number | 8562184808 |
| Mailing Telephone | 8565665202 |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2017-01-30 |
| Authorized Official Name | CARMEN CIERVO (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 8565665202 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 25MA04155300 | NJ | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Kennedy Health Alliance | Doing Business As Name - Organization |
| Street Address |
100 KINGS WAY E SUITE D2 |
| City | SEWELL |
| State | NJ |
| Zip Code | 08080-2237 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669452025 | Peter Stephen Konchak | Obstetrics & Gynecology | 100 Kings Way E, Suite # B5, Sewell, NJ 08080-2237 | 2006-01-20 |
| 1598303133 | Stc Pediatrics LLC | Pediatrics | 100 Kings Way E, Sewell, NJ 08080-2237 | 2019-12-13 |
| 1629513676 | Laura Massanova | Social Worker | 100 Kings Way E, Suite C-2, Sewell, NJ 08080-2237 | 2016-12-29 |
| 1013361955 | Tracey Gregory | Respiratory Therapist, Certified | 100 Kings Way E, Sewell, NJ 08080-2237 | 2016-04-18 |
| 1386003085 | Cornerstone Foot & Ankle | Podiatrist | 100 Kings Way E, Suite D6, Sewell, NJ 08080-2237 | 2016-02-23 |
| 1467823765 | New Jersey Podiatric Physicians & Surgeons Group, LLC | Podiatrist | 100 Kings Way E, Suite D6, Sewell, NJ 08080-2237 | 2015-10-13 |
| 1750778635 | Brenda Bartkovsky | Nurse Practitioner | 100 Kings Way E, Suite D2, Sewell, NJ 08080-2237 | 2015-04-19 |
| 1104240431 | Julaine Miller | Podiatrist | 100 Kings Way E, Suite D6, Sewell, NJ 08080-2237 | 2014-02-06 |
| 1659795144 | Josh Miller | Podiatrist | 100 Kings Way E, Suite D6, Sewell, NJ 08080-2237 | 2014-02-05 |
| 1487901633 | Frank Oware | Podiatrist | 100 Kings Way E, Suite D6, Sewell, NJ 08080-2237 | 2012-08-07 |
| Find all providers in the same location | ||||
| 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 | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629509435 | Suzanna Hosein | Family Medicine | 570 Egg Harbor Rd Ste C2, Sewell, NJ 08080-2359 | 2017-03-23 |
| 1033597786 | Robert Venuti Consulting, LLC | Family Medicine | 26 Clearbrook Ln, Sewell, NJ 08080-3320 | 2015-05-14 |
| 1639583990 | Craig Bober | Family Medicine | 660 Woodbury Glassboro Rd Ste 26, Sewell, NJ 08080-3738 | 2014-06-16 |
| 1811246515 | Lourdes Medical Associates, Pa | Family Medicine | 570 Egg Harbor Rd Ste B5, Sewell, NJ 08080-2359 | 2012-09-10 |
| 1568549335 | Joseph Cavallaro IIi | Family Medicine | 432 Ganttown Rd, Suite 202, Sewell, NJ 08080 | 2006-11-01 |
| 1831270610 | Diana Lorraine Saddel | Family Medicine | 543 Egg Harbor Rd, Sewell, NJ 08080-2335 | 2006-10-18 |
| 1073694535 | Kathleen A Bradley | Family Medicine | 239 Hurffville Crosskeys Rd Ste 160, Sewell, NJ 08080 | 2006-10-18 |
| 1508965310 | Donald Howard Stock | Family Medicine | 211 Countyhouse Road, Sewell, NJ 08080 | 2006-09-21 |
| 1649296294 | Kennedy University Hospital, Inc | Family Medicine | 445 Hurffville Crosskeys Rd Bldg A, Sewell, NJ 08080-2337 | 2006-07-15 |
| 1932144847 | Miles A Brumberg | Family Medicine | 601 Hurffville Crosskeys Rd, Sewell, NJ 08080-1748 | 2006-06-17 |
| Find all providers in SEWELL | ||||
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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.