Healthcare Provider Details

I. General information

NPI: 1275856429
Provider Name (Legal Business Name): MS. DENISE FLYN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 AMBOY RD
STATEN ISLAND NY
10306-2799
US

IV. Provider business mailing address

3155 AMBOY RD
STATEN ISLAND NY
10306-2799
US

V. Phone/Fax

Practice location:
  • Phone: 718-313-1470
  • Fax: 718-987-7449
Mailing address:
  • Phone: 718-313-1470
  • Fax: 718-987-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number324565-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: