Healthcare Provider Details

I. General information

NPI: 1013391911
Provider Name (Legal Business Name): JAMIE FLYNN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 K JOHNSON BLVD STE 101
BORDENTOWN NJ
08505-2275
US

IV. Provider business mailing address

1 3RD ST
BORDENTOWN NJ
08505-1321
US

V. Phone/Fax

Practice location:
  • Phone: 609-298-2005
  • Fax: 609-324-8267
Mailing address:
  • Phone: 609-298-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB10268200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: