Healthcare Provider Details

I. General information

NPI: 1437211133
Provider Name (Legal Business Name): ROBERT JOSEPH FLYNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 ROUTE 9 SUITE 306
CLIFTON PARK NY
12065-2498
US

IV. Provider business mailing address

1770 ROUTE 9 POB 486
CLIFTON PARK NY
12065-2498
US

V. Phone/Fax

Practice location:
  • Phone: 518-371-8899
  • Fax: 518-371-8803
Mailing address:
  • Phone: 518-371-8899
  • Fax: 518-371-8803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number118831
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: