Provider Demographics
NPI:1659361848
Name:KELLY, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:901 STEWART AVE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4893
Mailing Address - Country:US
Mailing Address - Phone:516-222-5555
Mailing Address - Fax:516-222-2778
Practice Address - Street 1:901 STEWART AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4893
Practice Address - Country:US
Practice Address - Phone:516-222-5555
Practice Address - Fax:516-222-2778
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2008-04-25
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Provider Licenses
StateLicense IDTaxonomies
NY197045207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0402279OtherGHI
NY1736445OtherUNITED
NY197045OtherHIP
NYG52095OtherMAGNACARE
NY01761715Medicaid
NYP2530558OtherOXFORD
NY197045-D40OtherHEALTHFIRST
NY8459916001OtherCIGNA
NY4C6364OtherHEALTHENET
NY0402279OtherGHI