MEDICARE: DR. LINDA SUSAN MULLEN 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	2084P0800X	Psychiatry Physician	201387	NY

General Provider Information

NPI Number	:	1780718114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA SUSAN MULLEN MD

Provider Business Mailing Address
First Line	:	25 W 81ST ST
Second Line	:	SUITE 1C
City	:	NEW YORK
State	:	NY
Zip	:	10024-6023
Country	:	US
Telephone Number	:	212-362-0142
Fax Number	:	212-362-6895

Provider Business Practice Location Address
First Line	:	25 W 81ST ST
Second Line	:	SUITE 1C
City	:	NEW YORK
State	:	NY
Zip	:	10024-6023
Country	:	US
Telephone Number	:	212-362-0142
Fax Number	:	212-362-6895

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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