Provider Demographics
NPI:1215136452
Name:HILDEBRAND, LYNNE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:MARIE
Last Name:HILDEBRAND
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 1:4 IRVING PL
Mailing Address - Street 2:ROOM 328
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3502
Mailing Address - Country:US
Mailing Address - Phone:212-780-7931
Mailing Address - Fax:
Practice Address - Street 1:4 IRVING PL
Practice Address - Street 2:ROOM 328
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3502
Practice Address - Country:US
Practice Address - Phone:212-780-7931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203226207Q00000X
VA51469207Q00000X
PAMD050914L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF99514Medicare UPIN