Provider Demographics
NPI:1306822010
Name:LIN, QUN I (MD)
Entity type:Individual
Prefix:
First Name:QUN
Middle Name:
Last Name:LIN
Suffix:I
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LACEY RD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-2951
Mailing Address - Country:US
Mailing Address - Phone:732-849-2743
Mailing Address - Fax:732-716-1413
Practice Address - Street 1:1100 ROUTE 72 W
Practice Address - Street 2:SUITE 305
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2468
Practice Address - Country:US
Practice Address - Phone:609-978-3359
Practice Address - Fax:609-978-3060
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08283600207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H60954Medicare UPIN
CT110008591Medicare ID - Type Unspecified