Provider Demographics
NPI:1285678425
Name:HERRERA, KELLY (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-0511
Mailing Address - Country:US
Mailing Address - Phone:845-294-4339
Mailing Address - Fax:845-294-4333
Practice Address - Street 1:ORANGE REGIONAL MEDICAL CENTER - HORTON CAMPUS
Practice Address - Street 2:60 PROSPECT ST
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-294-4339
Practice Address - Fax:845-294-4333
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221985207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02371644Medicaid
NY02371644Medicaid
NYH27819Medicare UPIN
NYA400033677Medicare PIN