Provider Demographics
NPI:1881688133
Name:PRINE, LINDA (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:PRINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3105
Mailing Address - Country:US
Mailing Address - Phone:212-206-5200
Mailing Address - Fax:212-691-2786
Practice Address - Street 1:16 E 16TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3105
Practice Address - Country:US
Practice Address - Phone:212-206-5200
Practice Address - Fax:212-691-2786
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00903700Medicaid
NY00903700Medicaid
NY65J771Medicare PIN