Provider Demographics
NPI:1558357574
Name:KELLY, IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:KELLY
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 1:510 ROUTE 304
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3041
Mailing Address - Country:US
Mailing Address - Phone:845-634-8400
Mailing Address - Fax:845-634-0979
Practice Address - Street 1:510 ROUTE 304
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3041
Practice Address - Country:US
Practice Address - Phone:845-634-8400
Practice Address - Fax:845-634-0979
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166838207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0123574OtherAETNA HMO ID#
NY0D4709OtherHEALTHNET ID #
NY160015223OtherRAILROAD MEDICARE ID #
NY40615591OtherAETNA PPO ID #
NY02E911OtherEMPIRE BC/BS NEW CITY #
NY166838OtherHIP #
NYRP023OtherOXFORD #
NY02E913OtherEMPIRE BC/BS STONY PT. #
NY000359OtherCONNECTICARE #
NY02E913OtherEMPIRE BC/BS STONY PT. #
NY40615591OtherAETNA PPO ID #
NYA60000Medicare UPIN