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General NPI Number Information
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NPI Number | 1780148668
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Entity Type | Individual
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Provider Name | CARLY LINICK PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 209 W STATE ST
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City | ITHACA
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State | NY
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Zip | 14850-5489
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Country | US
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Telephone | 607-277-4341
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Fax |
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Provider Business Mailing Address
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Address Line | 360 YELLOW BARN RD
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City | FREEVILLE
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State | NY
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Zip | 13068-9626
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Country | US
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Telephone | 607-351-9073
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 023146
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License Number State | NY
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