Provider Demographics
NPI:1639566086
Name:LIN, ANNIE (DO)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9729
Mailing Address - Country:US
Mailing Address - Phone:973-334-9404
Mailing Address - Fax:973-334-7615
Practice Address - Street 1:329 MAIN RD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9729
Practice Address - Country:US
Practice Address - Phone:973-334-9404
Practice Address - Fax:973-334-7615
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2MB10175700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine