Eileen Kelly, M.D.
Individual provider Active NPI Pediatrics Physician · East Moriches, NY
NPI 1689616773 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1689616773
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 202778 (NY)
- Practice address
- 492 Montauk Hwy
East Moriches, NY 11940-1347 - Phone
- (631) 878-8050
- NPI assigned
- Jun 12, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 202778 | NY | MD | Pediatrics Physician |
Interoperability endpoints
- eileen.kelly@pmuc.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 202778 | NY | Yes |
Addresses
Primary practice location
492 Montauk Hwy
East Moriches, NY 11940-1347
Mailing address
PO Box 1559
Stony Brook, NY 11790-0989
Phone (631) 878-8050
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01753460 | Medicaid | NY | |
| 542891 | Other | NY | EMPIRE BC.BS |
| 5659533 | Other | NY | AETNA |
Other providers in East Moriches, NY
- John V Celentano Phys, PC
- Jacquelyn M Jones
- Priscilla Karpin
- Megan Kasnicki
- Berna Kayas
- Rebecca A Kincade
- Jennifer Lynn Klingenberger-Beyer
- Lisa Kominos
- Stacy Ann Krey
- Melanie Kuklis
All providers in East Moriches, NY · Pediatrics Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.