Healthcare Provider Details

I. General information

NPI: 1477486850
Provider Name (Legal Business Name): NIE LINA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 61ST ST STE 203
BROOKLYN NY
11220-5163
US

IV. Provider business mailing address

80 CANDY LN
SYOSSET NY
11791-4912
US

V. Phone/Fax

Practice location:
  • Phone: 718-567-8686
  • Fax: 718-567-8666
Mailing address:
  • Phone: 917-256-9719
  • Fax: 718-567-8666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LINA NIE
Title or Position: MD
Credential: MD
Phone: 917-256-9719