Provider Demographics
NPI:1568741932
Name:LIN, CHALSEA RENEE (PA)
Entity Type:Individual
Prefix:MS
First Name:CHALSEA
Middle Name:RENEE
Last Name:LIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:YI MEI
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:690 FORT WASHINGTON AVE
Mailing Address - Street 2:#2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3730
Mailing Address - Country:US
Mailing Address - Phone:347-449-3088
Mailing Address - Fax:
Practice Address - Street 1:690 FORT WASHINGTON AVE
Practice Address - Street 2:#2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3730
Practice Address - Country:US
Practice Address - Phone:347-449-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014934363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical