Healthcare Provider Details

I. General information

NPI: 1942570338
Provider Name (Legal Business Name): HELEN KELLY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 SEGUINE AVE
STATEN ISLAND NY
10309-3932
US

IV. Provider business mailing address

375 SEGUINE AVE
STATEN ISLAND NY
10309-3932
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-2000
  • Fax:
Mailing address:
  • Phone: 718-226-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number465339
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: