Provider Demographics
NPI:1790914984
Name:FLYNN, PATRICK THOMAS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:THOMAS
Last Name:FLYNN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 HIGH STREET
Mailing Address - Street 2:CASC #205
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860
Mailing Address - Country:US
Mailing Address - Phone:973-579-2100
Mailing Address - Fax:973-579-6638
Practice Address - Street 1:222 HIGH STREET
Practice Address - Street 2:CASC #205
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860
Practice Address - Country:US
Practice Address - Phone:973-579-2100
Practice Address - Fax:973-579-6638
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00219100363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical