Provider Demographics
NPI:1487076188
Name:FELIZ, KERLYS
Entity type:Individual
Prefix:
First Name:KERLYS
Middle Name:
Last Name:FELIZ
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 1:2701 GRAND CONCOURSE APT 5H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-3708
Mailing Address - Country:US
Mailing Address - Phone:917-873-3669
Mailing Address - Fax:
Practice Address - Street 1:2701 GRAND CONCOURSE APT 5H
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3708
Practice Address - Country:US
Practice Address - Phone:917-873-3669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY811065141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist