Individual
DR. GERALD KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
181 N BELLE MEAD RD, EAST SETAUKET, NY 11733-3495
(111) 111-1111
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
197099
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01654411
—
NY
01
—
5932405
AETNA
NY
01
—
650571
EMPIRE BC.BS
NY
Enumeration date
06/27/2006
Last updated
09/29/2021
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