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Contact Information

KENNEDY MEDICAL GROUP PRACTICE P.C.
900 ROUTE 168
SUITE C#3
BLACKWOOD, NJ08012-3233
 Phone: 856-857-6920
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Prescribing (Medical)

103TP0016X 62 Psychologist, Clinical
 

Addiction (Substance Use Disorder)

103TA0400X 62 Psychologist, Clinical
 

Psychologist

103T00000X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for KENNEDY MEDICAL GROUP PRACTICE P.C.

NPI # 1497295109
LBN Legal business name KENNEDY MEDICAL GROUP PRACTICE P.C.
Authorized official CARMAN CIERVO - (CPE)
Entity Organization
Organization subpart 1 No
Enumeration date 02/28/2017
Last updated 02/28/2017 - About 9 years ago
Identifiers
NJ Medicaid 0411248
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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