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NPI Code Detail

MEDICARE: VICKI LIN PA

MEDICARE: VICKI LIN PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant034377NY

General Provider Information

NPI Number : 1164316444
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICKI LIN PA
Provider Business Mailing Address
First Line : 1276 FULTON AVE
Second Line :
City : BRONX
State : NY
Zip : 10456-3467
Country : US
Telephone Number : 718-992-7669
Fax Number :
Provider Business Practice Location Address
First Line : 1650 GRAND CONCOURSE
Second Line :
City : BRONX
State : NY
Zip : 10457-7679
Country : US
Telephone Number : 718-992-7669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2025
Last Update Date : 04/02/2026

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Directions to “ VICKI LIN PA” Practice Location

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