MEDICARE: MAGDALENE TONGO-KELLY

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	363LA2200X	Adult Health Nurse Practitioner	F306431	NY
2	363LA2200X	Adult Health Nurse Practitioner	306431	NY

General Provider Information

NPI Number	:	1770964249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGDALENE TONGO-KELLY

Provider Business Mailing Address
First Line	:	MAGDALENE TONGO-KELLY 1698 PARK PLACE APT 2
Second Line	:
City	:	BROOKLYN
State	:	NEW YORK
Zip	:	11233
Country	:	UM
Telephone Number	:	718-773-5089
Fax Number	:

Provider Business Practice Location Address
First Line	:	1698 PARK PL APT 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-4508
Country	:	US
Telephone Number	:	718-773-5089
Fax Number	:

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

Provider Enumeration Date	:	06/10/2015
Last Update Date	:	02/22/2018

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Directions to “ MAGDALENE TONGO-KELLY ” Practice Location

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