MEDICARE: MR. BRIAN KELLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	004042	NY

General Provider Information

NPI Number	:	1285969683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN KELLY

Provider Business Mailing Address
First Line	:	8230 138TH ST APT 6P
Second Line	:
City	:	BRIARWOOD
State	:	NY
Zip	:	11435-1477
Country	:	US
Telephone Number	:	646-510-5904
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 BELL BLVD
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-1730
Country	:	US
Telephone Number	:	347-857-9699
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2009
Last Update Date	:	07/21/2022

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