Individual
ALICE MARY KELLY-TOBIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
41 AVENUE A, HOLBROOK, NY 11741-2009
(631) 737-6179
Mailing address
41 AVENUE A, HOLBROOK, NY 11741-2009
(631) 737-6179
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
F340282-1
NY
Other
Enumeration date
04/10/2006
Last updated
08/03/2015
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