Individual
MR. KEVIN GEORGE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APN, C.
Contact information
Practice address
331 NORTH AVE, WOOD RIDGE, NJ 07075-2035
(201) 939-0409
Mailing address
331 NORTH AVE, WOOD RIDGE, NJ 07075-2035
(201) 939-0409
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
26NN10175200
NJ
Other
Enumeration date
02/04/2007
Last updated
08/13/2007
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