Healthcare Provider Details

I. General information

NPI: 1871533646
Provider Name (Legal Business Name): INA J KELEMEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 ROUTE 33 STE 100
FARMINGDALE NJ
07727-3797
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 732-851-8053
  • Fax: 732-851-8052
Mailing address:
  • Phone: 844-373-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA06083500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06083500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: