Provider Demographics
NPI:1609112432
Name:KELLY, JOHN JOSEPH (MSED, CAS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:KELLY
Suffix:
Gender:M
Credentials:MSED, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 WHISPERING HLS
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-1584
Mailing Address - Country:US
Mailing Address - Phone:845-478-5512
Mailing Address - Fax:845-913-1995
Practice Address - Street 1:4410 WHISPERING HLS
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-1584
Practice Address - Country:US
Practice Address - Phone:845-478-5512
Practice Address - Fax:845-913-1995
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7854849712255R0406X
AZ1938225CX0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind
No225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider