Provider Demographics
NPI:1912157025
Name:PARRY, LYNN ACKERMAN SR (MD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:ACKERMAN
Last Name:PARRY
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 WINDERMERE AVE
Mailing Address - Street 2:
Mailing Address - City:INTERLAKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4324
Mailing Address - Country:US
Mailing Address - Phone:732-531-1121
Mailing Address - Fax:
Practice Address - Street 1:633 WINDERMERE AVE
Practice Address - Street 2:
Practice Address - City:INTERLAKEN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4324
Practice Address - Country:US
Practice Address - Phone:732-531-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO1880100208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0000012894Medicare NSC