Provider Demographics
NPI:1518055243
Name:FLYNN, PATRICK JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:FLYNN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:J
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:340 FRONT ST
Mailing Address - Street 2:SUITE 102 HOFMANN PROFESSIONAL BLDG
Mailing Address - City:ELMER
Mailing Address - State:NJ
Mailing Address - Zip Code:08318
Mailing Address - Country:US
Mailing Address - Phone:856-358-3747
Mailing Address - Fax:856-358-8907
Practice Address - Street 1:340 FRONT ST
Practice Address - Street 2:SUITE 102 HOFMANN PROFESSIONAL BLDG
Practice Address - City:ELMER
Practice Address - State:NJ
Practice Address - Zip Code:08318
Practice Address - Country:US
Practice Address - Phone:856-358-3747
Practice Address - Fax:856-358-8907
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02755500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2320606Medicaid
NJFL152379Medicare ID - Type Unspecified
NJ2320606Medicaid