1437190451 NPI number — DR. KEVIN G FLANAGAN AV D

Table of content: DR. KEVIN G FLANAGAN AV D (NPI 1437190451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437190451 NPI number — DR. KEVIN G FLANAGAN AV D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLANAGAN
Provider First Name:
KEVIN
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AV D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437190451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
849 RT 5 & 20
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-934-2025
Provider Business Mailing Address Fax Number:
716-674-1836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
849 RT 5 & 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-934-2025
Provider Business Practice Location Address Fax Number:
716-674-1836
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  0014Z1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237600000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000576070004 . This is a "COMMUNITY BLUE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000576070005 . This is a "COMMUNITY BLUE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01899247 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040426002404 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00011388701 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02100250 . This is a "MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9210249 . This is a "INDEPENDENT HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011388702 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".




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