Healthcare Provider Details

I. General information

NPI: 1396677142
Provider Name (Legal Business Name): JEROD LIN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 N PAYNE ST
QUINCY MA
02169-7812
US

IV. Provider business mailing address

29 N PAYNE ST
QUINCY MA
02169-7812
US

V. Phone/Fax

Practice location:
  • Phone: 617-645-8572
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2390100
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: