Provider Demographics
NPI:1437190451
Name:FLANAGAN, KEVIN G (AV D)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:G
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:AV D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 RT 5 & 20
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:NY
Mailing Address - Zip Code:14081
Mailing Address - Country:US
Mailing Address - Phone:716-934-2025
Mailing Address - Fax:716-674-1836
Practice Address - Street 1:849 RT 5 & 20
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081
Practice Address - Country:US
Practice Address - Phone:716-934-2025
Practice Address - Fax:716-674-1836
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0014Z1231H00000X
NY237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000576070004OtherCOMMUNITY BLUE BCBS
000576070005OtherCOMMUNITY BLUE BCBS
NJ01899247Medicaid
NY040426002404OtherFIDELIS
NY00011388701OtherUNIVERA
02100250OtherMEDICAID
9210249OtherINDEPENDENT HEALTH
00011388702OtherUNIVERA
02100250OtherMEDICAID