Healthcare Provider Details

I. General information

NPI: 1295120228
Provider Name (Legal Business Name): KELLY CROWLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

5 THOREAU RD
HAMILTON NJ
08690-2116
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA10551700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: