Provider Demographics
NPI:1215110077
Name:LIN, ING LONG (MD)
Entity type:Individual
Prefix:
First Name:ING LONG
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 LAKEHURST RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8042
Mailing Address - Country:US
Mailing Address - Phone:732-240-2299
Mailing Address - Fax:
Practice Address - Street 1:495 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8042
Practice Address - Country:US
Practice Address - Phone:732-240-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02994000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ112927079OtherRAILROAD MEDICARE
NJ2061601Medicaid
NJ132845Medicare PIN
NJ112927079OtherRAILROAD MEDICARE