Provider Demographics
NPI:1710912100
Name:LIN, HENRY (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
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 1:10 CITY PLACE
Mailing Address - Street 2:APT 23C
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601
Mailing Address - Country:US
Mailing Address - Phone:914-437-9006
Mailing Address - Fax:
Practice Address - Street 1:622 WEST 168TH ST
Practice Address - Street 2:PH-1-137
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-09-26
Deactivation Date:2006-07-19
Deactivation Code:
Reactivation Date:2006-10-24
Provider Licenses
StateLicense IDTaxonomies
NY232280207P00000X
CT039795207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02419056Medicaid
H47091Medicare UPIN
NY1072Q1Medicare ID - Type Unspecified