Provider Demographics
NPI:1205944824
Name:KELLY, ANNE M (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:M
Last Name:KELLY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:333 EARLE OVINGTON BLVD
Mailing Address - Street 2:OMNI BUILDING
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3610
Mailing Address - Country:US
Mailing Address - Phone:516-357-8208
Mailing Address - Fax:516-222-6893
Practice Address - Street 1:333 EARLE OVINGTON BLVD
Practice Address - Street 2:OMNI BUILDING
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3610
Practice Address - Country:US
Practice Address - Phone:516-357-8208
Practice Address - Fax:516-222-6893
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
NY210036-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY81G502Medicare PIN
NYG79125Medicare UPIN