Nicholas Kelly

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1089 Manor LN
Bay Shore, NY 11706-6224

Phone

(631) 649-5834

NPI assigned

Oct 1, 2019

Last updated

Oct 1, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1569888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569888000000",
    "number": "1902447915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1089 MANOR LN",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117066224",
            "telephone_number": "631-649-5834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1089 MANOR LN",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117066224",
            "telephone_number": "631-649-5834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "NICHOLAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-01",
        "last_updated": "2019-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbie Kaufmann, C.P.T., C.N.
• Liam Patrick Kavanagh, MD
• Joseph Abraham Kavian
• Nadine Elizabeth Keefer, M.A., CF-SLP, TSSLD
• Colleen Mary Kelly, LMSW
• Tprene J Kelly, R.N.
• Kathleen Kelpy, OT
• Darius Kennedy
• Mary M Kenny Corron, LCSW
• Joanne Kent-Palumbo

• Student in an Organized Health Care Education/Training Program in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Student in an Organized Health Care Education/Training Program in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.