MEDICARE: DR. ANNE M. KELLY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	210036-1	NY

General Provider Information

NPI Number	:	1205944824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE M. KELLY M.D.

Provider Business Mailing Address
First Line	:	333 EARLE OVINGTON BLVD
Second Line	:	OMNI BUILDING
City	:	UNIONDALE
State	:	NY
Zip	:	11553-3610
Country	:	US
Telephone Number	:	516-357-8208
Fax Number	:	516-222-6893

Provider Business Practice Location Address
First Line	:	333 EARLE OVINGTON BLVD
Second Line	:	OMNI BUILDING
City	:	UNIONDALE
State	:	NY
Zip	:	11553-3610
Country	:	US
Telephone Number	:	516-357-8208
Fax Number	:	516-222-6893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/09/2007

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