Provider Demographics
NPI:1609372887
Name:FLANAGAN, THERESA B (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:B
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FRANK W BURR BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-6839
Mailing Address - Country:US
Mailing Address - Phone:201-304-7552
Mailing Address - Fax:
Practice Address - Street 1:400 FRANK W BURR BLVD STE 6
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-6839
Practice Address - Country:US
Practice Address - Phone:201-304-7552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00152022084P0800X
CT741522084P0800X
NJ25MA118048002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry