Healthcare Provider Details

I. General information

NPI: 1912115254
Provider Name (Legal Business Name): ANTHONY M FLYNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 CHRIS GAUPP DR STE 204
GALLOWAY NJ
08205-4487
US

IV. Provider business mailing address

436 CHRIS GAUPP DR STE 204
GALLOWAY NJ
08205-4487
US

V. Phone/Fax

Practice location:
  • Phone: 609-652-0100
  • Fax: 609-652-7616
Mailing address:
  • Phone: 609-652-0100
  • Fax: 609-652-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD433231
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA08939200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: