Provider Demographics
NPI:1124582275
Name:LIN, JIANSHENG (NY)
Entity Type:Individual
Prefix:
First Name:JIANSHENG
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:NY
Other - Prefix:MR
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NY
Mailing Address - Street 1:62 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3909
Mailing Address - Country:US
Mailing Address - Phone:347-238-0401
Mailing Address - Fax:
Practice Address - Street 1:62 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3909
Practice Address - Country:US
Practice Address - Phone:347-238-0401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care