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Contact Information

MICHAEL KELLY, DO
622 EAGLE ROCK AVE
SUITE 305
WEST ORANGE, NJ07052
 Phone: 973-736-1939
 Fax: 973-736-1937
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Sports Medicine

207RS0010X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for MICHAEL KELLY · (Male)

NPI # 1265583884
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 01/12/2007
Last updated 03/16/2026 - About 3 months ago
Sole proprietor 1 Yes
Identifiers
  • NJ License # 25MB07620900
  • NJ Other 7331613 AETNA PROVIDER NUMBER
  • NJ Other 1619025038 MEDICARE PIN SECOND OFFICE GROUP NUMBER
  • NJ Other P3389558 OXFORD PROVIDER NUMBER
  • NJ Other 203812206 TAX ID FOR SECOND OFFICE NJ SPORTS MEDICINE CENTER
Hospital affiliation(s)
  • SAINT BARNABAS MEDICAL CENTER - (Acute Care)
    94 OLD SHORT HILLS ROAD
    LIVINGSTON, NJ 07039
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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