Provider Demographics
NPI:1699835371
Name:LIN, MATTHEW MAU FU (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MAU FU
Last Name:LIN
Suffix:
Gender:M
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:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702
Mailing Address - Country:US
Mailing Address - Phone:631-661-6004
Mailing Address - Fax:631-661-2098
Practice Address - Street 1:626 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702
Practice Address - Country:US
Practice Address - Phone:631-661-6004
Practice Address - Fax:631-661-2098
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1224681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00663910Medicaid
NY00663910Medicaid
NY957371Medicare ID - Type Unspecified