Healthcare Provider Details

I. General information

NPI: 1326093097
Provider Name (Legal Business Name): LYNN TALIN CETIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PRO HEALTH PLZ
LAKE SUCCESS NY
11042-1111
US

IV. Provider business mailing address

2 PRO HEALTH PLZ
LAKE SUCCESS NY
11042-1111
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-7337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number204446
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: