Provider Demographics
NPI:1396039202
Name:SOO, LINDA CAROL (RN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:CAROL
Last Name:SOO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:
Other - Last Name:RAPAPORT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:311 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1701
Mailing Address - Country:US
Mailing Address - Phone:212-736-5900
Mailing Address - Fax:212-290-2724
Practice Address - Street 1:311 W 35TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1701
Practice Address - Country:US
Practice Address - Phone:212-736-5900
Practice Address - Fax:212-290-2724
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244735-1163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY244735-1Medicaid