Provider Demographics
NPI:1215266994
Name:LIN, ALYSEN (RT(R)(CT))
Entity type:Individual
Prefix:MISS
First Name:ALYSEN
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:RT(R)(CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4743
Mailing Address - Country:US
Mailing Address - Phone:516-717-8355
Mailing Address - Fax:
Practice Address - Street 1:920 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4743
Practice Address - Country:US
Practice Address - Phone:516-717-8355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY415387247100000X, 2471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography