Provider Demographics
NPI:1417049883
Name:LIN, RAYMOND H (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:H
Last Name:LIN
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MR
Other - First Name:MAUNG
Other - Middle Name:HTIN
Other - Last Name:ZAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:1572 LURTING AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1510
Mailing Address - Country:US
Mailing Address - Phone:718-409-0778
Mailing Address - Fax:718-409-0778
Practice Address - Street 1:17 BRISTOL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5629
Practice Address - Country:US
Practice Address - Phone:718-495-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007957-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical