Healthcare Provider Details

I. General information

NPI: 1285685651
Provider Name (Legal Business Name): LYNN SHIH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 TREMONT AVE
EAST ORANGE NJ
07018-1023
US

IV. Provider business mailing address

561 S SPRINGFIELD AVE
SPRINGFIELD NJ
07081-2919
US

V. Phone/Fax

Practice location:
  • Phone: 973-676-1000
  • Fax:
Mailing address:
  • Phone: 973-676-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNR65584
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: