Healthcare Provider Details

I. General information

NPI: 1982137857
Provider Name (Legal Business Name): KELLEY ANN CONSIDINE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEDICAL PLZ STE 102
GLEN COVE NY
11542-2101
US

IV. Provider business mailing address

10 MEDICAL PLZ STE 102
GLEN COVE NY
11542-2101
US

V. Phone/Fax

Practice location:
  • Phone: 516-676-0239
  • Fax:
Mailing address:
  • Phone: 516-676-0239
  • Fax: 516-676-0956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number302517
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: