Provider Demographics
NPI:1659361848
Name:KELLY, JAMES R (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E 60TH ST RM 602
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1811
Mailing Address - Country:US
Mailing Address - Phone:212-808-4888
Mailing Address - Fax:212-808-4999
Practice Address - Street 1:110 E 60TH ST RM 602
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1811
Practice Address - Country:US
Practice Address - Phone:212-808-4888
Practice Address - Fax:212-808-4888
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197045207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1736445OtherUNITED
NY197045-D40OtherHEALTHFIRST
NY0402279OtherGHI
NY4C6364OtherHEALTHENET
NY8459916001OtherCIGNA
NYG52095OtherMAGNACARE
NY01761715Medicaid
NYP2530558OtherOXFORD
NY197045OtherHIP
NY0402279OtherGHI