Patrick John Kelly, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

P91199 Issued in NY

Practice address

3318 Broadway
Astoria, NY 11106-1806

Phone

(718) 204-7550

Fax

(718) 204-7566

NPI assigned

Dec 17, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1387238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387238400000",
    "number": "1720409824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3854 NIAMI ST",
            "city": "SEAFORD",
            "state": "NY",
            "postal_code": "117833543",
            "telephone_number": "516-477-8325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3318 BROADWAY",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111061806",
            "telephone_number": "718-204-7550",
            "fax_number": "718-204-7566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "PATRICK",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-12-17",
        "last_updated": "2013-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "P91199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Demetrios Kehagias
• Vasilios Kehagias, C.P.O
• Kellen Ryan Scantlebury Physical Therapy PLLC
• Kellen Ryan Scantlebury Physical Therapy PLLC
• Janet Kelly
• Heather B Keltai, LMHC
• Stephen Kendall, LMHC
• Elizabeth Kent
• John Eugene Kenul
• David Kerrison, MD

• Physician Assistant in Astoria, NY
• Providers in Astoria, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.