Provider Demographics
NPI:1871649269
Name:DILLMAN, LINDA P (APRN-BC, GNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:P
Last Name:DILLMAN
Suffix:
Gender:F
Credentials:APRN-BC, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E5 CONTEMPRA CIR
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983-2035
Mailing Address - Country:US
Mailing Address - Phone:845-365-1224
Mailing Address - Fax:212-342-0200
Practice Address - Street 1:99 FORT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4655
Practice Address - Country:US
Practice Address - Phone:212-342-2290
Practice Address - Fax:212-342-0200
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340016363LG0600X
NJ26NN10125000363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00936907Medicaid
NY00936907Medicaid
NY92N331Medicare ID - Type Unspecified