Provider Demographics
NPI:1871533646
Name:KELEMEN, INA J (MD)
Entity type:Individual
Prefix:
First Name:INA
Middle Name:J
Last Name:KELEMEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-373-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:1175 ROUTE 33 STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07727-3797
Practice Address - Country:US
Practice Address - Phone:732-851-8053
Practice Address - Fax:732-851-8052
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06083500208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6811604Medicaid
NJ502863Medicare ID - Type Unspecified
NJG08257Medicare UPIN