Individual
DR. EILEEN KELLY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
492 MONTAUK HWY, EAST MORICHES, NY 11940-1347
(631) 878-8050
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
(631) 878-8050
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
202778
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01753460
—
NY
01
—
542891
EMPIRE BC.BS
NY
01
—
5659533
AETNA
NY
Enumeration date
06/12/2006
Last updated
07/08/2007
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