Provider Demographics
NPI:1366533770
Name:KENNEDY UNIVERSITY HOSPITAL INC.
Entity type:Organization
Organization Name:KENNEDY UNIVERSITY HOSPITAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-661-5144
Mailing Address - Street 1:PO BOX 13703
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3703
Mailing Address - Country:US
Mailing Address - Phone:856-661-5164
Mailing Address - Fax:856-661-5274
Practice Address - Street 1:300 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2373
Practice Address - Country:US
Practice Address - Phone:856-218-4990
Practice Address - Fax:856-256-9624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1080261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4140206Medicaid
NJ313517Medicare Oscar/Certification