Provider Demographics
NPI:1336820935
Name:LIN, LIN (CDN, LDN)
Entity type:Individual
Prefix:
First Name:LIN
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:CDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 SAUCON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-5078
Mailing Address - Country:US
Mailing Address - Phone:917-860-3017
Mailing Address - Fax:
Practice Address - Street 1:218 SAUCON VIEW DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-5078
Practice Address - Country:US
Practice Address - Phone:917-860-3017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007646133V00000X
NY011095133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered