Provider Demographics
NPI:1437211133
Name:FLYNN, ROBERT JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:FLYNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1770 ROUTE 9
Mailing Address - Street 2:POB 486
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2498
Mailing Address - Country:US
Mailing Address - Phone:518-371-8899
Mailing Address - Fax:518-371-8803
Practice Address - Street 1:1770 ROUTE 9
Practice Address - Street 2:SUITE 306
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2498
Practice Address - Country:US
Practice Address - Phone:518-371-8899
Practice Address - Fax:518-371-8803
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1188312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
37219BMedicare ID - Type Unspecified
NYC58893Medicare ID - Type Unspecified