Provider Demographics
NPI:1891125449
Name:KELLMAN, MORRIS (PT)
Entity Type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:
Last Name:KELLMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 51ST ST
Mailing Address - Street 2:APT. 5J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3558
Mailing Address - Country:US
Mailing Address - Phone:347-262-0104
Mailing Address - Fax:
Practice Address - Street 1:1370 51 STREET
Practice Address - Street 2:APT. 5J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:347-262-0104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist