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General NPI Number Information
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NPI Number | 1063420552
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Entity Type | Individual
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Provider Name | KELLEY JANNAE HALSTEAD MD
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Gender | Female
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 142 JORALEMON ST SUITE 4C-F
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City | BROOKLYN
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State | NY
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Zip | 11201-4709
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Country | US
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Telephone | 718-624-0604
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Fax |
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Provider Business Mailing Address
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Address Line | 300 LENOX RD APT 2L
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City | BROOKLYN
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State | NY
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Zip | 11226-2273
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Country | US
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Telephone | 718-941-0088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 238568
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License Number State | NY
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