Individual
MS. JACQUELINE ALLISON KIELTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A
Contact information
Practice address
104 FOREST AVE, GLEN COVE, NY 11542-2015
(516) 759-5406
Mailing address
36 COCKS LN, LOCUST VALLEY, NY 11560-2313
(516) 801-2571
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
011007
NY
Other
Enumeration date
04/14/2007
Last updated
07/08/2007
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