MEDICARE: DR. RICHIE L LIN MD

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	207N00000X	Dermatology Physician	240347	NY
2	207N00000X	Dermatology Physician	25MA08341900	NJ

General Provider Information

NPI Number	:	1417120932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHIE L LIN MD

Provider Business Mailing Address
First Line	:	636 MORRIS TPKE STE 2H
Second Line	:
City	:	SHORT HILLS
State	:	NJ
Zip	:	07078-2608
Country	:	US
Telephone Number	:	973-232-6245
Fax Number	:	973-232-6247

Provider Business Practice Location Address
First Line	:	636 MORRIS TPKE STE 2H
Second Line	:
City	:	SHORT HILLS
State	:	NJ
Zip	:	07078-2608
Country	:	US
Telephone Number	:	973-232-6245
Fax Number	:	973-232-6247

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

Provider Enumeration Date	:	04/04/2008
Last Update Date	:	09/18/2023

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