Kelly, Michael

Kelly, Michael is an sole proprietor health care provider with primary practice located at 776 Northfield Ave , West Orange NJ 07052. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Kelly, Michael can be contacted via phone (973) 736-1939.

Contact Information

Primary practice address
776 Northfield Ave West Orange NJ 07052
Phone: (973) 736-1939
Fax: (973) 736-1937
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207RS0010X 25MB07620900 New Jersey

Profile Details

NPI number 1265583884
LBN Legal business name Kelly, Michael
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 12th, 2007
Last updated May 3rd, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265583884 NPPES
New Jersey Other 203812206 TAX ID FOR SECOND OFFICE NJ SPORTS MEDICINE CENTER
New Jersey Other 7331613 TAX ID FOR SECOND OFFICE NJ SPORTS MEDICINE CENTER
New Jersey Other 1619025038 TAX ID FOR SECOND OFFICE NJ SPORTS MEDICINE CENTER
New Jersey Other P3389558 TAX ID FOR SECOND OFFICE NJ SPORTS MEDICINE CENTER

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