MEDICARE: ANN KELLY INC.

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1972851970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN KELLY INC.

Provider Business Mailing Address
First Line	:	6602 74TH ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11379-2230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6602 74TH ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11379-2230
Country	:	US
Telephone Number	:	917-499-0773
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ANN KELLY
Credential	:	RN
Telephone Number	:	917-499-0773

Provider Enumeration Date	:	08/22/2012
Last Update Date	:	08/22/2012

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Directions to “ANN KELLY INC. ” Practice Location

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