Provider Demographics
NPI:1750499455
Name:KANELLAKOS, JAMES G (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:G
Last Name:KANELLAKOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 JAMES ST
Mailing Address - Street 2:SUITE 3F
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960
Mailing Address - Country:US
Mailing Address - Phone:973-538-0029
Mailing Address - Fax:973-538-4957
Practice Address - Street 1:261 JAMES ST - 3F
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-538-0029
Practice Address - Fax:973-538-0029
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239267207X00000X, 207XX0801X
NJ25MA08242200207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
I52152Medicare UPIN
RB0360Medicare ID - Type Unspecified