Healthcare Provider Details

I. General information

NPI: 1003720699
Provider Name (Legal Business Name): AMY E CORRIGAN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY ELIZABETH FLYNN LAC

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 VALLEY RD APT 2
MONTCLAIR NJ
07043-1796
US

IV. Provider business mailing address

410 VALLEY RD APT 2
MONTCLAIR NJ
07043-1796
US

V. Phone/Fax

Practice location:
  • Phone: 718-938-6097
  • Fax:
Mailing address:
  • Phone: 718-938-6097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37AC00929200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: