Provider Demographics
NPI:1861411969
Name:KELLY, BETTY ANN (MD)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:ANN
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:BUILDING #19, WEST ROAD
Mailing Address - Street 2:MITCHEL COMPLEX FAMILY HEALTH CENTER
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-6720
Mailing Address - Country:US
Mailing Address - Phone:516-222-0228
Mailing Address - Fax:516-745-1519
Practice Address - Street 1:BLDG. #19 , WEST RD.
Practice Address - Street 2:MITCHEL COMPLEX FAMILY HEALTH CENTER
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-222-0228
Practice Address - Fax:516-745-1519
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-12-09
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Provider Licenses
StateLicense IDTaxonomies
NY175095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE87427Medicare UPIN