Provider Demographics
NPI:1346251485
Name:LIN, PI-TANG (MD)
Entity type:Individual
Prefix:
First Name:PI-TANG
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133-29 41ST ROAD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3671
Mailing Address - Country:US
Mailing Address - Phone:718-939-7750
Mailing Address - Fax:718-939-7568
Practice Address - Street 1:133-29 41ST ROAD
Practice Address - Street 2:SUITE 2C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3671
Practice Address - Country:US
Practice Address - Phone:718-939-7750
Practice Address - Fax:718-939-7568
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133386207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00537462Medicaid
C09631Medicare UPIN
06700Medicare ID - Type Unspecified