1457330672 NPI number — KENNEDY UNIVERSITY HOSPITAL INC

Table of content: (NPI 1457330672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457330672 NPI number — KENNEDY UNIVERSITY HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNEDY UNIVERSITY HOSPITAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457330672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13704
Provider Second Line Business Mailing Address:
30TH STREET STATION
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19101-3704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-782-9064
Provider Business Mailing Address Fax Number:
856-782-9068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 WALNUT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINDENWOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08021-7555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-782-9064
Provider Business Practice Location Address Fax Number:
856-782-9068
Provider Enumeration Date:
01/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FORSYTH
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
856-627-5409

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  KENN00301 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7809506 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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