Individual ProviderJacob Nathaniel KellyStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address169 Riverside Dr, Binghamton, NY 13905-4246(607) 798-5111(607) 259-1148PECOS EnrollmentBased on the most recent information from CMS, provider Jacob Nathaniel Kelly does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1023713856Provider TypeIndividualFull NameKelly, Jacob NathanielTitleDr.CredentialMDGenderMaleSole ProprietorNoEnumeration Date4/3/2023Last Updated4/3/2023Contact InformationPractice LocationPractice Address169 Riverside Dr, Binghamton, NY 13905-4246Phone(607) 798-5111FaxUnlisted FaxMailing LocationMailing Address8 Woodland Ave, Cortland, NY 13045-1824Phone(607) 259-1148FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerNew York