Provider Demographics
NPI:1386239127
Name:KIELY, BRENDON WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:BRENDON
Middle Name:WILLIAM
Last Name:KIELY
Suffix:
Gender:M
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:CARRIER AIR WING 3
Mailing Address - Street 2:UNIT 60106
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARRIER AIR WING 3
Practice Address - Street 2:UNIT 60106
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09504
Practice Address - Country:US
Practice Address - Phone:914-330-5779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider