Provider Demographics
NPI:1477793511
Name:REID, LINDA ANNE (NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANNE
Last Name:REID
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:ANNE
Other - Last Name:REID-MEEKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1 WASHINGTON SQUARE VLG
Mailing Address - Street 2:#14J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1632
Mailing Address - Country:US
Mailing Address - Phone:212-673-1194
Mailing Address - Fax:
Practice Address - Street 1:369 E 149TH STREET,
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455
Practice Address - Country:US
Practice Address - Phone:718-772-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380610363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01468666Medicaid
NY1383G1Medicare PIN
NYQ57710Medicare UPIN