Provider Demographics
NPI:1043373384
Name:KELLEY, WILLIAM SCOTT (DPM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SCOTT
Last Name:KELLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 S SPRUCE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2549
Mailing Address - Country:US
Mailing Address - Phone:201-327-1115
Mailing Address - Fax:201-327-4766
Practice Address - Street 1:35 S SPRUCE ST FL 1
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2549
Practice Address - Country:US
Practice Address - Phone:201-327-1115
Practice Address - Fax:201-327-4766
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01285213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1743601Medicaid
NJKE608571Medicare ID - Type Unspecified
NJ1743601Medicaid