Healthcare Provider Details

I. General information

NPI: 1528532686
Provider Name (Legal Business Name): CATHERINE MARGARET FLYNN PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 ROUTE 112 STE 11
MEDFORD NY
11763-2535
US

IV. Provider business mailing address

5423 FORT HAMILTON PKWY APT A4
BROOKLYN NY
11219-4014
US

V. Phone/Fax

Practice location:
  • Phone: 631-732-5222
  • Fax: 631-732-6222
Mailing address:
  • Phone: 917-796-6029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number382931
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: