Provider Demographics
NPI:1093770950
Name:LYNEN, RICHARD F (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
Last Name:LYNEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:254 EASTON AVE
Mailing Address - Street 2:MOB 4TH FLOOR
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1766
Mailing Address - Country:US
Mailing Address - Phone:732-745-8600
Mailing Address - Fax:732-249-3475
Practice Address - Street 1:254 EASTON AVE
Practice Address - Street 2:WOMEN'S AMBULATORY CLINIC
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1766
Practice Address - Country:US
Practice Address - Phone:732-745-8520
Practice Address - Fax:732-828-8929
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA56658207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7462808Medicaid
NJ7462808Medicaid
NJF78669Medicare UPIN