Provider Demographics
NPI:1053310151
Name:VIKNER, LIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:LIN
Middle Name:M
Last Name:VIKNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 W RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2359
Mailing Address - Country:US
Mailing Address - Phone:201-689-9968
Mailing Address - Fax:201-689-9978
Practice Address - Street 1:1 W RIDGEWOOD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2359
Practice Address - Country:US
Practice Address - Phone:201-689-9968
Practice Address - Fax:201-689-9978
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA064685207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
005640Medicare ID - Type Unspecified
G63537Medicare UPIN