Look up the most recent NPI and PECOS records

Kennedy Medical Group Practice, P.C.

(<Unavail>)

Family Medicine

Allopathic & Osteopathic Physicians

333 Laurel Oak Rd, Voorhees, NJ 08043-4453

(856) 783-1987 (800) 941-8933

PECOS Enrollment

Based on the most recent information from CMS, provider Kennedy Medical Group Practice, P.C. does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1952726796
Provider Type
Organization
Full Name
Kennedy Medical Group Practice, P.C.
Other Name
<Unavail>

Subpart
Yes
Enumeration Date
3/4/2014
Last Updated
6/8/2021

Contact Information

Practice Location

333 Laurel Oak Rd, Voorhees, NJ 08043-4453

(856) 783-1987

Unlisted Fax

Mailing Location

PO Box 824967, Philadelphia, PA 19182-4967

(800) 941-8933

(732) 918-8940

Authorized Official

Perez, Ricardo (Vp Of Clinical Services)

(856) 218-5634

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 207R00000X	Description Internal Medicine Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 207RE0101X	Description Internal Medicine Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 207V00000X	Description Obstetrics & Gynecology Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 2084N0400X	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 2086S0129X	Description Surgery Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 208D00000X	Description General Practice Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 208G00000X	Description Thoracic Surgery (Cardiothoracic Vascular Surgery) Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 208M00000X	Description Hospitalist Allopathic & Osteopathic Physicians	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID 0411248	Description Medicaid	Issuer Unlisted New Jersey

Kennedy Medical Group Practice, P.C.

(<Unavail>)

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

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Description

License

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Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

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Description

Issuer

ID

Description

Issuer