Healthcare Provider Details

I. General information

NPI: 1780643940
Provider Name (Legal Business Name): JAMES E LYNCH P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 FAIRVIEW AVE
BRICK NJ
08724-4314
US

IV. Provider business mailing address

92 FAIRVIEW AVE
BRICK NJ
08724-4314
US

V. Phone/Fax

Practice location:
  • Phone: 917-747-3562
  • Fax:
Mailing address:
  • Phone: 917-747-3562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00095200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5620234
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: