Provider Demographics
NPI:1699031906
Name:LIN, NYSSA (DDS)
Entity Type:Individual
Prefix:
First Name:NYSSA
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 E 70TH ST
Mailing Address - Street 2:26M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5342
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:435 E 70TH ST
Practice Address - Street 2:26M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5342
Practice Address - Country:US
Practice Address - Phone:626-203-3855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056762-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice