Provider Demographics
NPI:1265716864
Name:LIN, DONG L
Entity type:Individual
Prefix:MR
First Name:DONG
Middle Name:L
Last Name:LIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1972
Mailing Address - Country:US
Mailing Address - Phone:732-306-8881
Mailing Address - Fax:
Practice Address - Street 1:1147 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07062-1934
Practice Address - Country:US
Practice Address - Phone:908-757-7703
Practice Address - Fax:908-757-2084
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-01
Last Update Date:2011-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI0275353500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist