Provider Demographics
NPI:1518274752
Name:ARCHIDIACONO, KELLY ANNE (DPT)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANNE
Last Name:ARCHIDIACONO
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Gender:F
Credentials:DPT
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Mailing Address - Street 1:1536 3RD AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2167
Mailing Address - Country:US
Mailing Address - Phone:212-861-2630
Mailing Address - Fax:212-861-2685
Practice Address - Street 1:226 E 54TH ST
Practice Address - Street 2:SUITE #304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4854
Practice Address - Country:US
Practice Address - Phone:212-371-7001
Practice Address - Fax:212-371-7011
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2012-01-31
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Provider Licenses
StateLicense IDTaxonomies
NY033064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist