Provider Demographics
NPI:1790779544
Name:ORDING-BAUER, LINDA (NP, MS)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:ORDING-BAUER
Suffix:
Gender:F
Credentials:NP, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WHINSTONE ST
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1020
Mailing Address - Country:US
Mailing Address - Phone:631-444-4715
Mailing Address - Fax:631-444-4695
Practice Address - Street 1:205 N. BELLE MEADE RD
Practice Address - Street 2:STONY BROOK UNIVERSITY MEDICAL CENTER PRIMARY CARE
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-9252
Practice Address - Country:US
Practice Address - Phone:631-444-4715
Practice Address - Fax:631-444-4695
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301549363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03057325Medicaid