Individual
KELSEY MARIE PELLICONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1978 CROMPOND RD, CORTLANDT MANOR, NY 10567-4111
(914) 739-2121
Mailing address
1978 CROMPOND RD, CORTLANDT MANOR, NY 10567-4111
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
020695
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04786994
—
NY
Enumeration date
03/15/2017
Last updated
10/10/2019
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