Provider Demographics
NPI:1952550006
Name:LIN, IRENE C (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:C
Last Name:LIN
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 1:71 GLEN COVE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1056
Mailing Address - Country:US
Mailing Address - Phone:516-625-8804
Mailing Address - Fax:
Practice Address - Street 1:71 GLEN COVE RD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1056
Practice Address - Country:US
Practice Address - Phone:516-625-8804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-13
Last Update Date:2008-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099033207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY573861Medicare PIN
NYB77932Medicare UPIN