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General NPI Number Information
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NPI Number | 1144974379
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Entity Type | Individual
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Provider Name | KELLY LAUREN ENG
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Gender | Female
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Dates
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Enumeration Date | 02/07/2022
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 1283 YORK AVE 4TH FL
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City | NEW YORK
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State | NY
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Zip | 10065
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Country | US
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Telephone | 646-962-2330
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Fax |
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Provider Business Mailing Address
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Address Line | 2614 JACKSON AVE APT 11G
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-2967
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Country | US
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Telephone | 631-896-9157
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F347698
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License Number State | NY
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