Healthcare Provider Details

I. General information

NPI: 1356301428
Provider Name (Legal Business Name): MARY G FLANAGAN-KUNDLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 STATE ROUTE 31 STE 111
FLEMINGTON NJ
08822-4953
US

IV. Provider business mailing address

329 E MAIN ST STE 3
SMITHTOWN NY
11787-2821
US

V. Phone/Fax

Practice location:
  • Phone: 908-782-4316
  • Fax:
Mailing address:
  • Phone: 631-265-1855
  • Fax: 631-724-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00856000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001163
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: