Provider Demographics
NPI:1356737373
Name:GROVES, KELLEY
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:GROVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 E 34TH ST FL STREET9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4901
Mailing Address - Country:US
Mailing Address - Phone:212-263-2377
Mailing Address - Fax:212-263-4985
Practice Address - Street 1:424 E 34TH ST FL STREET9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4901
Practice Address - Country:US
Practice Address - Phone:212-263-2377
Practice Address - Fax:212-263-4985
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.133074208000000X
NY3109812080P0203X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics