Healthcare Provider Details

I. General information

NPI: 1487917837
Provider Name (Legal Business Name): LINA MIYAKAWA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIRST AVENUE AND E16 STREET
NEW YORK NY
10003-2604
US

IV. Provider business mailing address

150 E 42ND ST FL 9
NEW YORK NY
10017-5699
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-2377
  • Fax:
Mailing address:
  • Phone: 646-605-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA12115100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA12115100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA12115100
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number281446
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number281446
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: