Healthcare Provider Details

I. General information

NPI: 1245492818
Provider Name (Legal Business Name): ANTON GEORGE KELLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST BOX 116
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH STREET BOX 116
NEW YORK NY
10065
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-8485
  • Fax:
Mailing address:
  • Phone: 212-988-2075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT192522
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number60-276050
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: