Healthcare Provider Details

I. General information

NPI: 1316961048
Provider Name (Legal Business Name): THOMAS E FLYNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 W 165TH ST BOX 92
NEW YORK NY
10032-3724
US

IV. Provider business mailing address

635 W 165TH ST BOX 92
NEW YORK NY
10032-3724
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-3039
  • Fax:
Mailing address:
  • Phone: 212-305-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number173604-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: