Healthcare Provider Details

I. General information

NPI: 1972432094
Provider Name (Legal Business Name): YOLANDA KELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 BROADWAY
PATERSON NJ
07514-1923
US

IV. Provider business mailing address

75 UNION ST APT 2A
HACKENSACK NJ
07601-4100
US

V. Phone/Fax

Practice location:
  • Phone: 973-820-5432
  • Fax:
Mailing address:
  • Phone: 973-820-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: