Individual
MR. GERARD P KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
550 BROADWAY STE 201, MASSAPEQUA, NY 11758-5013
(516) 815-3134
Mailing address
550 BROADWAY STE 201, MASSAPEQUA, NY 11758-5013
(516) 815-3134
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
008693
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
658606689
DRIVERS LICENSE
NY
Enumeration date
09/16/2008
Last updated
09/16/2008
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