Individual
JOHN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
382 W PASSAIC AVE, BLOOMFIELD, NJ 07003-5552
(973) 338-1900
(973) 761-0112
Mailing address
382 W PASSAIC AVE, BLOOMFIELD, NJ 07003-5552
(973) 338-1900
(973) 761-0112
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MA51866
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1753606
—
NJ
Enumeration date
08/27/2006
Last updated
08/21/2013
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