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General NPI Number Information
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NPI Number | 1184904302
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Entity Type | Individual
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Provider Name | LINA NIE MD, PHD
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Gender | Female
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Dates
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Enumeration Date | 08/18/2011
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 749 61ST STREET UNIT 203
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City | BROOKLYN
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State | NY
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Zip | 11220-4211
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Country | US
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Telephone | 718-567-8686
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Fax | 718-567-8666
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Provider Business Mailing Address
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Address Line | 80 CANDY LN
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City | SYOSSET
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State | NY
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Zip | 11791-4912
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Country | US
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Telephone | 917-256-9719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 275698
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License Number State | NY
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