MEDICARE: DR. LINA NIE MD, PHD

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
1	208000000X	Pediatrics Physician	275698	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184904302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINA NIE MD, PHD

Provider Business Mailing Address
First Line	:	80 CANDY LN
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-4912
Country	:	US
Telephone Number	:	917-256-9719
Fax Number	:

Provider Business Practice Location Address
First Line	:	749 61ST STREET
Second Line	:	UNIT 203
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4211
Country	:	US
Telephone Number	:	718-567-8686
Fax Number	:	718-567-8666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2011
Last Update Date	:	02/09/2021

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