Healthcare Provider Details

I. General information

NPI: 1376164368
Provider Name (Legal Business Name): TIFFANY LIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL RD
PATCHOGUE NY
11772-4870
US

IV. Provider business mailing address

101 HOSPITAL RD
PATCHOGUE NY
11772-4870
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-1900
  • Fax:
Mailing address:
  • Phone: 631-475-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number321653
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: