Dr. James Thomas Kelly, DO
Family Medicine in Port Jefferson, NY. Individual provider (NPI-1).
NPI number1508943317
StatusActive
Last updated in NPPESNov 19, 2009
Details
- NPI
- 1508943317
- Entity type
- Individual (NPI-1)
- Name
- Dr. James Thomas Kelly
- Credential
- DO
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 1, 2006
- Last updated
- Nov 19, 2009
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - FAMILY PRACTICE
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 173786 | NY | Yes |
Practice location
70 N Country RdSuite 105
Port Jefferson, NY 11777-2161
Phone 631-642-0609 · Fax 631-642-0588
Mailing address
70 N Country RdSuite 105
Port Jefferson, NY 11777-2161
Phone 631-642-0609 · Fax 631-642-0588
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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