Individual
KEALA LANDRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
355 GRAND ST, JERSEY CITY, NJ 07302-4321
(201) 915-2218
Mailing address
201 E 12TH ST, APT. PH7, NEW YORK, NY 10003-9128
(917) 533-9537
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25MA07788400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00204475
RAILROAD
—
Enumeration date
10/03/2006
Last updated
04/01/2008
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