Provider Demographics
NPI:1831152586
Name:LIN, ANDREW ZAW (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ZAW
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ZAW
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11 SWEET BRIAR PATH
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1850
Mailing Address - Country:US
Mailing Address - Phone:631-689-8889
Mailing Address - Fax:631-689-8882
Practice Address - Street 1:365 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3145
Practice Address - Country:US
Practice Address - Phone:631-854-1300
Practice Address - Fax:631-854-1269
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110139687OtherRR MEDICARE
NYG16087Medicare UPIN