MEDICARE: DR. STEPHEN T LINCKS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	NY148305	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	089553	OTHER		VALUE OPTIONS

General Provider Information

NPI Number	:	1053532341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN T LINCKS MD

Provider Business Mailing Address
First Line	:	137 BROADWAY
Second Line	:	STE J
City	:	AMITYVILLE
State	:	NY
Zip	:	11701-2731
Country	:	US
Telephone Number	:	631-598-2791
Fax Number	:	631-598-2792

Provider Business Practice Location Address
First Line	:	137 BROADWAY
Second Line	:	STE J
City	:	AMITYVILLE
State	:	NY
Zip	:	11701-2731
Country	:	US
Telephone Number	:	631-598-2791
Fax Number	:	631-598-2792

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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