Provider Demographics
NPI:1184761850
Name:KENNEDY CARE CENTER,P.A.
Entity type:Organization
Organization Name:KENNEDY CARE CENTER,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-783-0695
Mailing Address - Street 1:705 WHITE HORSE RD
Mailing Address - Street 2:SUITE D-102
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2468
Mailing Address - Country:US
Mailing Address - Phone:856-783-0695
Mailing Address - Fax:856-783-8083
Practice Address - Street 1:705 WHITE HORSE RD
Practice Address - Street 2:SUITE D-102
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2468
Practice Address - Country:US
Practice Address - Phone:856-783-0695
Practice Address - Fax:856-783-8083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB31922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ139335A4KMedicare PIN
NJE79633Medicare UPIN