Paul Mitchell Kelleher DO LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

206597 Issued in NY

Legal business name

PAUL MITCHELL KELLEHER DO LLC

Practice address

49 W Rayburn Rd
Millington, NJ 07946-1502

Phone

(908) 542-1792

NPI assigned

Jan 29, 2013

Organization subpart

No

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

Authorized official

Name

Paul Mitchell KelleherNPI 1326052473

Title

Owner

Phone

(908) 647-1148

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paul Mitchell Kelleher, D.O.

  • Physical Medicine & Rehabilitation Physician
  • Millington, NJ
  • NPI 1326052473
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1359417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430784000000",
    "number": "1871831669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 W RAYBURN RD",
            "city": "MILLINGTON",
            "state": "NJ",
            "postal_code": "079461502",
            "telephone_number": "908-542-1792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 W RAYBURN RD",
            "city": "MILLINGTON",
            "state": "NJ",
            "postal_code": "079461502",
            "telephone_number": "908-542-1792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL MITCHELL KELLEHER DO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-29",
        "last_updated": "2015-05-05",
        "status": "A",
        "authorized_official_last_name": "KELLEHER",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "MITCHELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-647-1148"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NJ",
            "license": "MB069632",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "206597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02057174",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Home Roots Safety Solutions
• Paul Mitchell Kelleher, D.O.
• Dana Angela Loria
• Jessica Lynn Lukaszek, OTR
• Our House, Inc.
• Yardena Raban, HEALTH COACH
• Thomasine M. Rosenthal, LCSW
• Jennifer A Scalera
• Lina Slim, MA, CCC-SLP,BCBA
• Glenn Alan Smith, THERAPIST

• Physical Medicine & Rehabilitation Physician in Millington, NJ
• Providers in Millington, NJ by specialty
• Physical Medicine & Rehabilitation Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.