Healthcare Provider Details

I. General information

NPI: 1568190734
Provider Name (Legal Business Name): KATHRYN LIND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JAMAICA HOUSE CENTER 90-04 161ST ST. 5TH FLOOR
JAMAICA NY
11432-6103
US

IV. Provider business mailing address

60 MADISON AVE FL 5
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 718-523-2123
  • Fax: 718-523-5833
Mailing address:
  • Phone: 212-545-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF404248
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: