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General NPI Number Information
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NPI Number | 1598148041
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Entity Type | Organization
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Legal Business Name | DR. HORTENSIA KELLY PA
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 01/21/2016
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Provider Practice Location Address
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Address Line | 111 CENTRAL AVE SUITE 519
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City | NEWARK
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State | NJ
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Zip | 07102-1909
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Country | US
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Telephone | 973-877-5222
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Fax |
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Provider Business Mailing Address
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Address Line | 111 CENTRAL AVE SUITE 519
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City | NEWARK
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State | NJ
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Zip | 07102-1909
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Country | US
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Telephone | 973-877-5222
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. HORTENSIA KELLY
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Credential | D.O
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Telephone | 973-877-5222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MB08441500
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License Number State | NJ
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