Provider Demographics
NPI:1255531000
Name:FLYNN GAMENG, MARY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:FLYNN GAMENG
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 1:300 EAST MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1220
Mailing Address - Country:US
Mailing Address - Phone:631-979-6466
Mailing Address - Fax:631-979-6475
Practice Address - Street 1:300 E MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2900
Practice Address - Country:US
Practice Address - Phone:631-979-6466
Practice Address - Fax:631-979-6475
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245192208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics