Provider Demographics
NPI:1679688378
Name:LIN, LAWRENCE CHENG (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:CHENG
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WEI-CHENG
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:258 CRABAPPLE RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1709
Mailing Address - Country:US
Mailing Address - Phone:516-869-4200
Mailing Address - Fax:
Practice Address - Street 1:258 CRABAPPLE RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1709
Practice Address - Country:US
Practice Address - Phone:516-869-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48682208200000X
NY248595208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
I58690Medicare UPIN
MN240000314Medicare ID - Type Unspecified
MN704600000Medicaid