Provider Demographics
NPI:1821047929
Name:ING-LONG LIN MD PA
Entity Type:Organization
Organization Name:ING-LONG LIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ING-LONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-240-2299
Mailing Address - Street 1:495 LAKEHURST ROAD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8042
Mailing Address - Country:US
Mailing Address - Phone:732-240-2299
Mailing Address - Fax:732-505-5311
Practice Address - Street 1:495 LAKEHURST ROAD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8042
Practice Address - Country:US
Practice Address - Phone:732-240-2299
Practice Address - Fax:732-505-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02994000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2061601Medicaid
NJC53462Medicare UPIN
NJ132845Medicare PIN