MEDICARE: DEENA LINN PA-C

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	363AM0700X	Medical Physician Assistant		NY

General Provider Information

NPI Number	:	1487172748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEENA LINN PA-C

Provider Business Mailing Address
First Line	:	1500 ROUTE 112 STE 101
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-8054
Country	:	US
Telephone Number	:	631-751-3000
Fax Number	:	631-751-3000

Provider Business Practice Location Address
First Line	:	12 E 86TH ST OFC 4C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-0517
Country	:	US
Telephone Number	:	212-861-6660
Fax Number	:	631-751-0506

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

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	02/28/2022

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Directions to “ DEENA LINN PA-C” Practice Location

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