Individual
KERRY KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
545 CLAWSON ST, STATEN ISLAND, NY 10306-4251
(718) 667-1477
Mailing address
545 CLAWSON ST, STATEN ISLAND, NY 10306-4251
(718) 667-1477
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
137284
NY
Other
Enumeration date
09/14/2005
Last updated
07/08/2007
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