Provider Demographics
NPI:1376797696
Name:FLYNN, ROBERT J (MA OT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:FLYNN
Suffix:
Gender:M
Credentials:MA OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MOUNT PLEASANT LN
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-1023
Mailing Address - Country:US
Mailing Address - Phone:212-420-0510
Mailing Address - Fax:
Practice Address - Street 1:292 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6307
Practice Address - Country:US
Practice Address - Phone:212-420-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004358-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist