Individual
DESIREE DIANE NELSON-KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.M
Contact information
Practice address
3000 ESSEX RD, TINTON FALLS, NJ 07753-2631
(732) 643-2070
(732) 643-2015
Mailing address
5525 RESEARCH PARK DRIVE, BALTIMORE, MD 21228-4664
(732) 643-2070
(732) 643-2015
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
MD002581
NJ
213EP1101X
Primary Podiatric Medicine Podiatrist
N005661-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27-07975
EVERCARE
—
01
—
522114204D
BCBS OF NJ
—
05
—
8393907
—
NJ
Enumeration date
06/01/2006
Last updated
05/06/2015
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