Provider Demographics
NPI:1780695403
Name:KELLY, PATRICK J (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14 SUTTON PL S
Mailing Address - Street 2:11C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3071
Mailing Address - Country:US
Mailing Address - Phone:212-751-7751
Mailing Address - Fax:
Practice Address - Street 1:14 SUTTON PL S
Practice Address - Street 2:11C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3071
Practice Address - Country:US
Practice Address - Phone:212-751-7751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY139544207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
134042827OtherCIGNA
134042827OtherEMPIRE UNITED
NZ1334OtherHEALTHNET
134042827OtherUNITED HEALTHCARE
2268392OtherAETNA HMO
0022378OtherGHI
139544OtherHIP
134042827Other1199
4353813OtherAETNA PPO
2268392OtherAETNA HMO