Provider Demographics
NPI:1871112946
Name:KELVY, KRISTINA MARIANNA
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIANNA
Last Name:KELVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BARBARY LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-2309
Mailing Address - Country:US
Mailing Address - Phone:609-462-8937
Mailing Address - Fax:
Practice Address - Street 1:8900 VAN WYCK EXPRESSWAY
Practice Address - Street 2:DEPARTMENT OF FAMILY MEDICINE
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11418
Practice Address - Country:US
Practice Address - Phone:718-206-6919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine