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General NPI Number Information
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NPI Number | 1912768425
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Entity Type | Organization
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Legal Business Name | CLINICAL PRACTICE OF LECOM INSTITUTE FOR SUCCESSFUL LIVING
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 5401 PEACH ST STE 3400
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City | ERIE
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State | PA
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Zip | 16509-2601
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Country | US
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Telephone | 814-868-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 5401 PEACH ST STE 3400
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City | ERIE
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State | PA
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Zip | 16509-2601
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Country | US
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Telephone | 814-868-2200
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES Y LIN
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Credential | DO
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Telephone | 814-602-7783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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