Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X005778 | NY |
NPI | 1467537316 |
---|---|
Provider Name | Dr. Richard K Kelly |
First Address | Bridgehampton, NY 11932 |
Second Address | Bridgehampton, NY 11932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U1810892 | (02) |