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General NPI Number Information
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NPI Number | 1083869168
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Entity Type | Individual
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Provider Name | JOHN GERARD FLYNN PTA
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Gender | Male
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Dates
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Enumeration Date | 11/17/2008
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Last Update Date | 11/17/2008
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Provider Practice Location Address
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Address Line | 10 UNION SQ E SUITE 5N
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City | NEW YORK
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State | NY
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Zip | 10003-3314
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Country | US
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Telephone | 212-844-8772
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Fax |
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Provider Business Mailing Address
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Address Line | 8439 153RD AVE APT 3M
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City | HOWARD BEACH
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State | NY
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Zip | 11414-1946
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Country | US
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Telephone | 917-335-5792
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 006128-1
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License Number State | NY
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