Individual
COLLEEN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
170 WILLIAM ST, NEW YORK, NY 10038-2612
(212) 312-5000
Mailing address
809 6TH ST, E NORTHPORT, NY 11731-2114
(631) 338-9022
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
09/06/2018
Last updated
09/06/2018
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