Individual
PAUL E KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 OLD COUNTRY ROAD, SUITE 16, RIVERHEAD, NY 11901-2145
(631) 574-3419
(631) 727-8110
Mailing address
660 WHITE PLAINS RD FL 4, TARRYTOWN, NY 10591-5139
(914) 984-2546
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
230368
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02646179
—
NY
01
—
P0108756
RAILROAD MEDICARE PIN
NY
Enumeration date
08/15/2005
Last updated
04/02/2019
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