Individual
EILEEN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
47 HUMPHREY DR, SYOSSET, NY 11791-4022
(516) 921-7171
(516) 921-8130
Mailing address
19 JEFFERSON AVE, MASSAPEQUA PARK, NY 11762-2613
(516) 798-8681
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
5111
NY
Other
Enumeration date
06/27/2012
Last updated
06/27/2012
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