Healthcare Provider Details

I. General information

NPI: 1588641567
Provider Name (Legal Business Name): YUHLIN LIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 PALISADE AVE
JERSEY CITY NJ
07306-1121
US

IV. Provider business mailing address

PO BOX 51045
NEWARK NJ
07101-5145
US

V. Phone/Fax

Practice location:
  • Phone: 201-945-2481
  • Fax: 201-943-8105
Mailing address:
  • Phone: 201-945-2481
  • Fax: 201-943-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA06368200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7013701
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: