Provider Demographics
NPI:1699861914
Name:KENNEDY MEMORIAL HOSPITALS-UNIVERSITY MEDICAL CENTER
Entity type:Organization
Organization Name:KENNEDY MEMORIAL HOSPITALS-UNIVERSITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:LARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-661-5144
Mailing Address - Street 1:PO BOX 48023
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-4823
Mailing Address - Country:US
Mailing Address - Phone:856-661-5164
Mailing Address - Fax:856-661-5274
Practice Address - Street 1:2201 CHAPEL AVE W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2048
Practice Address - Country:US
Practice Address - Phone:856-488-6500
Practice Address - Fax:856-488-6526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10401276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4140206Medicaid
NJ4140206Medicaid