Provider Demographics
NPI:1215335799
Name:SCHOLTZ-ASSANI, LYNN DESLINE
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:DESLINE
Last Name:SCHOLTZ-ASSANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 124TH ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-2616
Mailing Address - Country:US
Mailing Address - Phone:917-332-8704
Mailing Address - Fax:
Practice Address - Street 1:3110 THOMSON AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-3007
Practice Address - Country:US
Practice Address - Phone:718-482-5935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009691-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant