NPIMap

Individual provider Active NPI

Maureen Jeanette Kelly, P.A.

  • Physician Assistant
  • Commack, NY
National Provider Identifier
1235275959
Registry record updated Apr 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
003748-1 Issued in NY
Practice address
68 Hauppauge Rd
Commack, NY 11725-4403
Phone
(631) 715-2503
NPI assigned
Jan 29, 2007
Last updated
Apr 14, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 003748-1 NY Primary

Addresses

Primary practice location

68 Hauppauge Rd
Commack, NY 11725-4403

Mailing address

65 Columbus Ave
Smithtown, NY 11787-4624
Phone (631) 366-0679

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100720000869 NY Practitioner - Physician Assistant 4183756547 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-1560

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-1560

Lauterbur Dr
Stony Brook, NY 11794-0001
Phone (632) 638-1000

PO Box
Suite 1554
Stony Brook, NY 11790-0989

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
003748-1NYMDCounselor
003748NYMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Internists, University Faculty Practice Corporation CurrentSince Jul 21, 2025 Accepting new patients
The Rosalind and Joseph Gurwin Jewish Geriatric Center of Long Island CurrentSince May 7, 2010 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation CurrentSince Jul 21, 2025 Accepting new patients
Mid Island Medical Associates, PLLC PastSince Jun 23, 2025 Accepting new patients
Eric Spronz, Psychiatric Nurse Practitioner P.C. PastSince Oct 4, 2020 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation Past Accepting new patients

Locations

68 Hauppauge Rd
Commack, NY 11725
Phone (631) 499-6500

4 Smith Haven Mall
Ste 203
Lake Grove, NY 11755
Phone (631) 444-0561

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

100 Nicolls Rd
#13202
Stony Brook, NY 11794

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428969600000",
    "number": "1235275959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 COLUMBUS AVE",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117874624",
            "telephone_number": "631-366-0679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68 HAUPPAUGE RD",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117254403",
            "telephone_number": "631-715-2503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MAUREEN",
        "middle_name": "JEANETTE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2015-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "003748-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Commack, NY

Sources for this page

Verify at the official NPI Registry.