| Organization Name: | KENNEDY MEDICAL GROUP PRACTICE, P.C. |
| NPI Number: | 1073884847 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KATHY SCHLEIDER (VP CLINICAL INTEGRATION) |
| Mailing Address: | 333 Laurel Oak Rd Voorhees |
| State: | NJ US |
| Postal Code: | 080434453 |
| Phone Number: | 8567830191 |
| Fax Number: | 8567830264 |
| NPI Enumeration Date: | 01/25/2012 |
| NPI Last Update Date: | 10/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0129X |
| License Number: | 25MA09025500 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Vascular Surgery |
| Taxonomy Definition: | A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |