Provider Demographics
NPI:1780671446
Name:FLYNN RICHARDS, EILEEN BRIDGET (NP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:BRIDGET
Last Name:FLYNN RICHARDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3551
Mailing Address - Country:US
Mailing Address - Phone:631-737-6434
Mailing Address - Fax:631-738-1226
Practice Address - Street 1:2539 MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-3551
Practice Address - Country:US
Practice Address - Phone:631-737-6434
Practice Address - Fax:631-738-1226
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3011071363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01908901Medicaid
S62186Medicare UPIN
NY01908901Medicaid