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General NPI Number Information
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NPI Number | 1073773578
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Entity Type | Individual
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Provider Name | LAWRENCE WILLIAM KELLY JR. MD
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Gender | Male
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | STONY BROOK UNIVERSITY HOSPITAL DEPARTMENT OF EMERGENCY MEDICINE, HSC, L-4, ROOM 080
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City | STONY BROOK
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State | NY
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Zip | 11794-0001
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Country | US
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Telephone | 631-444-3880
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Fax | 631-444-6031
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Provider Business Mailing Address
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Address Line | STONY BROOK UNIVERSITY HOSPITAL DEPARTMENT OF EMERGENCY MEDICINE, HSC, L-4, ROOM 080
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City | STONY BROOK
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State | NY
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Zip | 11794-0001
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Country | US
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Telephone | 631-444-3880
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Fax | 631-444-6031
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 257499
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License Number State | NY
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