Individual
JONATHAN KELVAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
101 NICOLLS RD, STONY BROOK, NY 11794-0001
(631) 444-2034
Mailing address
101 NICOLLS RD, STONY BROOK, NY 11794-0001
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
019220
NY
363AS0400X
Surgical Physician Assistant
Primary
019220
NY
Other
Enumeration date
11/17/2015
Last updated
06/01/2023
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