Individual
ANNA B KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
81 E CLINTON AVE, TENAFLY, NJ 07670-2102
(201) 233-5726
Mailing address
81 E CLINTON AVE, TENAFLY, NJ 07670-2102
(201) 233-5726
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
154584-1
NY
2085R0202X
Diagnostic Radiology Physician
154584-1
NY
2085R0202X
Diagnostic Radiology Physician
Primary
MA52932
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01202868
—
NY
01
—
02186203
MEDICAID GROUP #
NY
01
—
W35021
MEDICARE GROUP #
NY
Enumeration date
07/05/2006
Last updated
02/03/2021
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