Provider Demographics
NPI:1780643940
Name:LYNCH, JAMES E (PA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:LYNCH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-4314
Mailing Address - Country:US
Mailing Address - Phone:917-747-3562
Mailing Address - Fax:
Practice Address - Street 1:92 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-4314
Practice Address - Country:US
Practice Address - Phone:917-747-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00095200363A00000X
NY5620234363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MJ0006OtherHEALTHNET
062969QQXMedicare ID - Type Unspecified
P68718Medicare UPIN