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Individual

ANDREW NICHOLAS KELLY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
589 3RD AVE, NEW YORK, NY 10016-2711
(212) 658-6791
(212) 867-4353
Mailing address
129 W 29TH ST FL 10, NEW YORK, NY 10001-5105
(415) 658-6791
(415) 520-0904

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
024491
NY
363AM0700X
Medical Physician Assistant
Primary
024491
NY
363AM0700X
Medical Physician Assistant
MA059231
PA

Other

Enumeration date
06/19/2017
Last updated
03/07/2024
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