Healthcare Provider Details

I. General information

NPI: 1518110899
Provider Name (Legal Business Name): JAMES JAY FLYNN III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 INDUSTRIAL WAY W
EATONTOWN NJ
07724-4240
US

IV. Provider business mailing address

246 INDUSTRIAL WAY W
EATONTOWN NJ
07724-4240
US

V. Phone/Fax

Practice location:
  • Phone: 732-676-2630
  • Fax:
Mailing address:
  • Phone: 732-676-2630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA02567400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: