Basic Information
| Provider Information | |||||||||
| NPI: | 1164764544 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIN | ||||||||
| FirstName: | JAMES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 NORTHERN BLVD | ||||||||
| Address2: | STE 216 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110215200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312345666 | ||||||||
| FaxNumber: | 6312340539 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 MOTOR PKWY STE A2 | ||||||||
| Address2: | |||||||||
| City: | HAUPPAUGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117885112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312345666 | ||||||||
| FaxNumber: | 6312340539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2013 | ||||||||
| LastUpdateDate: | 10/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | ME132155 | FL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.