Provider Demographics
NPI:1295048502
Name:HANRETTA, KELLY C (DO)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:C
Last Name:HANRETTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:77 PONDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3809
Mailing Address - Country:US
Mailing Address - Phone:914-681-1210
Mailing Address - Fax:914-681-2839
Practice Address - Street 1:41 EAST POST ROAD
Practice Address - Street 2:ATTN: ADMINISTRATION/MEDICAL STAFF OFFICE
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601
Practice Address - Country:US
Practice Address - Phone:914-681-1210
Practice Address - Fax:914-681-2839
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08792600207R00000X
CT67486207RC0000X
NY269430207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1295048502OtherNPI