Provider Demographics
NPI:1568448314
Name:PERRY-BOTTINGER, LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:
Last Name:PERRY-BOTTINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LYNNE
Other - Middle Name:
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:140A LOCKWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4920
Mailing Address - Country:US
Mailing Address - Phone:914-576-7577
Mailing Address - Fax:914-576-7377
Practice Address - Street 1:140A LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4920
Practice Address - Country:US
Practice Address - Phone:914-576-7577
Practice Address - Fax:914-576-7377
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206637207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01741120Medicaid
NY01741120Medicaid
719481Medicare ID - Type Unspecified