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General NPI Number Information
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NPI Number | 1235308172
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Entity Type | Individual
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Provider Name | SOPHIA VIVIAN LIN D.C.
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Gender | Female
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 379 OLD TOWN RD
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-2245
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Country | US
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Telephone | 631-680-7368
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Fax |
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Provider Business Mailing Address
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Address Line | 81 WESTCHESTER DR
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City | ROCKY POINT
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State | NY
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Zip | 11778-8875
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Country | US
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Telephone | 631-680-7368
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Fax | 631-928-8340
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X011650-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | X011650-1
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License Number State | NY
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