Organization
PAUL MITCHELL KELLEHER DO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL MITCHELL KELLEHER (OWNER)
(908) 647-1148
Entity
Organization
Contact information
Practice address
49 W RAYBURN RD, MILLINGTON, NJ 07946-1502
(908) 542-1792
Mailing address
49 W RAYBURN RD, MILLINGTON, NJ 07946-1502
(908) 542-1792
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
206597
NY
208100000X
Physical Medicine & Rehabilitation Physician
MB069632
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02057174
—
NY
Enumeration date
01/29/2013
Last updated
05/05/2015
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