Provider Demographics
NPI:1881634418
Name:KELLY, MICHAEL ALOYSIUS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALOYSIUS
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:360 ESSEX ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-8550
Mailing Address - Country:US
Mailing Address - Phone:551-996-8867
Mailing Address - Fax:551-996-8873
Practice Address - Street 1:360 ESSEX ST
Practice Address - Street 2:SUITE 303
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8550
Practice Address - Country:US
Practice Address - Phone:551-996-8867
Practice Address - Fax:551-996-8873
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06606800207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086505DHKMedicare ID - Type Unspecified
NY47D781Medicare PIN
NJB80440Medicare UPIN