Provider Demographics
NPI:1730114547
Name:LINK, RICHARD ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLAN
Last Name:LINK
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 1:15 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1411
Mailing Address - Country:US
Mailing Address - Phone:914-479-0994
Mailing Address - Fax:718-388-5029
Practice Address - Street 1:170 FROST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-1404
Practice Address - Country:US
Practice Address - Phone:718-388-6629
Practice Address - Fax:718-388-5029
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129171207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00305133Medicaid
110024714Medicare PIN
NY00305133Medicaid
NYC08889Medicare UPIN