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General NPI Number Information
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NPI Number | 1659030898
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Entity Type | Individual
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Provider Name | LAWRENCE KELLY
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Gender | Male
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Dates
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Enumeration Date | 12/15/2021
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 801 NEW YORK AVE
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City | TRENTON
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State | NJ
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Zip | 08638-3913
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Country | US
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Telephone | 855-740-1921
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Fax |
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Provider Business Mailing Address
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Address Line | 2701 RENAISSANCE BLVD FL 4
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-2781
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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