Healthcare Provider Details

I. General information

NPI: 1558980623
Provider Name (Legal Business Name): KELSEY MCMANUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE 3060N
HAWTHORNE NY
10532-2180
US

IV. Provider business mailing address

19 BRADHURST AVE STE 3060N
HAWTHORNE NY
10532-2180
US

V. Phone/Fax

Practice location:
  • Phone: 914-372-7887
  • Fax:
Mailing address:
  • Phone: 914-372-7887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number323873
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number323873
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: