Active NPI
John Peter Kelly, PH.D.
- Psychologist
- Smithtown, NY
National Provider Identifier
1174718597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 9859
- Practice address
- 267 Middle Country Rd
Smithtown, NY 11787-2874 - Phone
- (631) 366-3166
- NPI assigned
- Sep 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 9859 | NY | Primary |
Addresses
Primary practice location
267 Middle Country Rd
Smithtown, NY 11787-2874
Mailing address
267 Middle Country Rd
Smithtown, NY 11787-2874
Phone (631) 366-3166
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9859 | NY | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189382400000",
"number": "1174718597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "267 MIDDLE COUNTRY RD",
"city": "SMITHTOWN",
"state": "NY",
"postal_code": "117872874",
"telephone_number": "631-366-3166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "267 MIDDLE COUNTRY RD",
"city": "SMITHTOWN",
"state": "NY",
"postal_code": "117872874",
"telephone_number": "631-366-3166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JOHN",
"middle_name": "PETER",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-10",
"last_updated": "2007-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "9859",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Smithtown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.