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General NPI Number Information
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NPI Number | 1154429660
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Entity Type | Individual
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Provider Name | SUSAN E KELLY FNP
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 1 GATEWAY CTR STE 2600
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City | NEWARK
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State | NJ
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Zip | 07102-5323
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Country | US
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Telephone | 888-731-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 1 GATEWAY CTR STE 2600
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City | NEWARK
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State | NJ
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Zip | 07102-5323
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Country | US
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Telephone |
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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 | 26NJ00309500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 393481-1
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License Number State | NY
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