Provider Demographics
NPI:1164079232
Name:LIN, JIANMIN (FNP)
Entity Type:Individual
Prefix:MR
First Name:JIANMIN
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8252 164TH PL FL 1
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1825
Mailing Address - Country:US
Mailing Address - Phone:917-833-8848
Mailing Address - Fax:
Practice Address - Street 1:3916 PRINCE ST STE 354
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5367
Practice Address - Country:US
Practice Address - Phone:917-833-8848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34483133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty