MEDICARE: LAWRENCE KELLEHER DO

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	306720-01	NY

General Provider Information

NPI Number	:	1790045219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE KELLEHER DO

Provider Business Mailing Address
First Line	:	130 W KINGSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-3904
Country	:	US
Telephone Number	:	718-584-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 W KINGSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-3904
Country	:	US
Telephone Number	:	718-584-9000
Fax Number	:

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

Provider Enumeration Date	:	05/17/2012
Last Update Date	:	02/03/2026

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