=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740061050
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY MICHELE KALAMARAS NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2023
-----------------------------------------------------
Last Update Date | 10/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 PORT WASHINGTON BLVD
-----------------------------------------------------
City | ROSLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11576-1347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-562-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 GRAND AVE APT B6
-----------------------------------------------------
City | ROCKVILLE CENTRE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11570-4210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-225-2955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | F311545-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------