Healthcare Provider Details

I. General information

NPI: 1003816604
Provider Name (Legal Business Name): NANCY I. LINNEMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CRYSTAL RUN RD
MIDDLETOWN NY
10941-4028
US

IV. Provider business mailing address

155 CRYSTAL RUN RD
MIDDLETOWN NY
10941-4028
US

V. Phone/Fax

Practice location:
  • Phone: 845-703-6999
  • Fax: 845-703-6297
Mailing address:
  • Phone: 845-703-6999
  • Fax: 845-703-6297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number191566
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number191566
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number191566
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: