Basic Information
| Provider Information | |||||||||
| NPI: | 1386746592 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KENNEDY UNIVERSITY HOSPITAL INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 787032 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191787032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566615164 | ||||||||
| FaxNumber: | 8566615274 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 E LAUREL RD | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080841327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563466000 | ||||||||
| FaxNumber: | 8563466005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 10/03/2022 | ||||||||
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| AuthorizedOfficialLastName: | LARIO | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8566615144 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | 10403 | NJ | N | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care | 282N00000X | 10403 | NJ | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 4140206 | 05 | NJ | MEDICAID |