Provider Demographics
NPI:1699024174
Name:HISLOP, KELLY M
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:M
Last Name:HISLOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 48TH ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2017
Mailing Address - Country:US
Mailing Address - Phone:516-353-3240
Mailing Address - Fax:
Practice Address - Street 1:124 48TH ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2017
Practice Address - Country:US
Practice Address - Phone:516-353-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist