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NPI Code Detail

MEDICARE: DR. ALYSSA KELLMYER DPM

MEDICARE: DR. ALYSSA KELLMYER DPM
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
1213ES0103XFoot & Ankle Surgery Podiatrist25MD00385700NJ
2213E00000XPodiatrist25MD00385700NJ

General Provider Information

NPI Number : 1548992415
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALYSSA KELLMYER DPM
Provider Business Mailing Address
First Line : 100 KINGS WAY E STE D608084
Second Line :
City : SEWELL
State : NJ
Zip : 08080-2237
Country : US
Telephone Number : 856-582-6082
Fax Number :
Provider Business Practice Location Address
First Line : 18 E LAUREL RD
Second Line :
City : STRATFORD
State : NJ
Zip : 08084-1327
Country : US
Telephone Number : 856-346-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2022
Last Update Date : 06/18/2026

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