Provider Demographics
NPI:1184904302
Name:NIE, LINA (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:LINA
Middle Name:
Last Name:NIE
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 CANDY LN
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4912
Mailing Address - Country:US
Mailing Address - Phone:917-256-9719
Mailing Address - Fax:
Practice Address - Street 1:749 61ST STREET
Practice Address - Street 2:UNIT 203
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4211
Practice Address - Country:US
Practice Address - Phone:718-567-8686
Practice Address - Fax:718-567-8666
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275698208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04009761Medicaid