Provider Demographics
NPI:1922202738
Name:KELLY, ROBERT B (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:KELLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 659
Mailing Address - Street 2:
Mailing Address - City:LANOKA HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08734-0659
Mailing Address - Country:US
Mailing Address - Phone:609-242-2705
Mailing Address - Fax:609-242-2702
Practice Address - Street 1:823 LACEY RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1203
Practice Address - Country:US
Practice Address - Phone:609-242-2705
Practice Address - Fax:609-242-2702
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB06389400208VP0014X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM