Provider Demographics
NPI:1598949885
Name:MODEL, LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:
Last Name:MODEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 50TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3309
Mailing Address - Country:US
Mailing Address - Phone:718-283-7384
Mailing Address - Fax:
Practice Address - Street 1:984 50TH ST FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3309
Practice Address - Country:US
Practice Address - Phone:718-283-7384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036134954208600000X
FLME124351208600000X
NY287034-12086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery