MEDICARE: JAMES J KELLY D.O.

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	207XS0106X	Orthopaedic Hand Surgery Physician	189303	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OPCOS189303	OTHER	NY	WORKERS COMPENSATION BOAR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0905716	OTHER	NY	INDEPENDENT HEALTH
4	000524163001	OTHER	NY	BLUE CROSS BLUE SHIELD
5	00010089101	OTHER	NY	UNIVERA

General Provider Information

NPI Number	:	1871593053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES J KELLY D.O.

Provider Business Mailing Address
First Line	:	3925 SHERIDAN DR
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14226-1738
Country	:	US
Telephone Number	:	716-250-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	3925 SHERIDAN DR
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14226-1738
Country	:	US
Telephone Number	:	716-250-9999
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	03/01/2018

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Directions to “ JAMES J KELLY D.O.” Practice Location

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