Provider Demographics
NPI:1114381910
Name:FORD, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 8TH AVE APT 4G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3056
Mailing Address - Country:US
Mailing Address - Phone:910-315-1528
Mailing Address - Fax:646-838-9139
Practice Address - Street 1:2730 8TH AVE APT 4G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-3056
Practice Address - Country:US
Practice Address - Phone:910-315-1528
Practice Address - Fax:646-838-9139
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34391870411R376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide