Provider Demographics
NPI:1700404027
Name:LIN, AMY J (DC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:LIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3047 73RD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1418
Mailing Address - Country:US
Mailing Address - Phone:347-705-2326
Mailing Address - Fax:
Practice Address - Street 1:720 SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2518
Practice Address - Country:US
Practice Address - Phone:347-705-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00777600111N00000X
NY013379111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor