Healthcare Provider Details

I. General information

NPI: 1285731745
Provider Name (Legal Business Name): KELLY G. USSERY-KRONHAUS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY GILAINE USSERY M.D.

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 JACK MARTIN BLVD STE 5
BRICK NJ
08724-7778
US

IV. Provider business mailing address

331 NEWMAN SPRINGS RD BLDG 2, STE 220
RED BANK NJ
07701-5688
US

V. Phone/Fax

Practice location:
  • Phone: 732-458-8000
  • Fax: 732-458-8020
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA07942700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: