Provider Demographics
NPI:1487153425
Name:SHEN-HAN LIN MEDICAL PC
Entity type:Organization
Organization Name:SHEN-HAN LIN MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHEN-HAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-509-8499
Mailing Address - Street 1:13342 39TH AVE STE 253
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4516
Mailing Address - Country:US
Mailing Address - Phone:718-888-0566
Mailing Address - Fax:
Practice Address - Street 1:13342 39TH AVE STE 253
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4516
Practice Address - Country:US
Practice Address - Phone:718-772-3187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03427745Medicaid