Provider Demographics
NPI:1023294402
Name:JOHN J. KELLEY ASSOC., LTD
Entity type:Organization
Organization Name:JOHN J. KELLEY ASSOC., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREDSIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:V
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:215-545-0939
Mailing Address - Street 1:1528 WALNUT ST
Mailing Address - Street 2:SUITE 1801
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3604
Mailing Address - Country:US
Mailing Address - Phone:214-545-0939
Mailing Address - Fax:215-545-0938
Practice Address - Street 1:1528 WALNUT ST
Practice Address - Street 2:SUITE 1801
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3604
Practice Address - Country:US
Practice Address - Phone:214-545-0939
Practice Address - Fax:215-545-0938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0340570001Medicare NSC