Provider Demographics
NPI:1093794836
Name:LIN, LIN (MD)
Entity Type:Individual
Prefix:
First Name:LIN
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5782
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:325 ESSJAY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8243
Practice Address - Country:US
Practice Address - Phone:716-630-2582
Practice Address - Fax:716-630-2594
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY236680-1207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000528225001OtherHEALTH NOW
NY236680OtherNYS LICENSE REGISTRATION
NY161000580OtherEMPIRE PLAN
NY02684733Medicaid
NY161000580OtherNORTH AMERICAN PREFERRED
NY00027259902OtherUNIVERA
NY1112968OtherIHA