Provider Demographics
NPI:1417947748
Name:KELLY, DENNIS HUGHES III (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:HUGHES
Last Name:KELLY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7704 MARINE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-6203
Mailing Address - Country:US
Mailing Address - Phone:201-869-1313
Mailing Address - Fax:201-854-7945
Practice Address - Street 1:7704 MARINE RD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-6203
Practice Address - Country:US
Practice Address - Phone:201-869-1313
Practice Address - Fax:201-854-7945
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA74287207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
H73828Medicare UPIN
NJ064517ABCMedicare ID - Type Unspecified