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General NPI Number Information
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NPI Number | 1174886147
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Entity Type | Organization
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Legal Business Name | JOHN J KELLY VISION CONSULTING, LLC
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Dates
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Enumeration Date | 06/24/2012
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Last Update Date | 12/26/2012
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Provider Practice Location Address
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Address Line | 4410 WHISPERING HLS
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City | CHESTER
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State | NY
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Zip | 10918-1584
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Country | US
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Telephone | 845-478-5512
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Fax | 845-913-1995
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Provider Business Mailing Address
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Address Line | 4410 WHISPERING HLS
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City | CHESTER
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State | NY
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Zip | 10918-1584
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Country | US
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Telephone | 845-478-5512
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Fax | 845-913-1995
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MR. JOHN JOSEPH KELLY
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Credential | MS.ED, CAS
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Telephone | 845-478-5512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 3166421
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License Number State | NY
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