| John V. Kelly Md, Pc | |
|
382 W Passaic Ave Bloomfield NJ 07003-5552 | |
| (973) 338-1900 | |
| Not Available |
| Full Name | John V. Kelly Md, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 382 W Passaic Ave, Bloomfield, New Jersey |
| Authorized Official Name and Position | John Kelly (PRESIDENT) |
| Authorized Official Contact | 9733381900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John V. Kelly Md, Pc 382 W Passaic Ave Bloomfield NJ 07003-5552 Ph: (973) 338-1900 | John V. Kelly Md, Pc 382 W Passaic Ave Bloomfield NJ 07003-5552 Ph: (973) 338-1900 |
| NPI Number | 1417065830 |
|---|---|
| Provider Enumeration Date | 08/27/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 9638106891 |
|---|---|
| Medicare Enrollment ID | O20050722000051 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417065830 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | John V Kelly |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265540686 PECOS PAC ID: 4486681376 Enrollment ID: I20050726000036 |
| Provider Name | Jessy Samuel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154940450 PECOS PAC ID: 1052728359 Enrollment ID: I20210405000610 |
| Provider Name | Scott Carmine Masullo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568189322 PECOS PAC ID: 4789053034 Enrollment ID: I20221208003042 |
| Provider Name | Natalie Rose Graziano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891402376 PECOS PAC ID: 3577932219 Enrollment ID: I20221220000020 |
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