MEDICARE: IRENE C LIN M.D.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	099033	NY

General Provider Information

NPI Number	:	1952550006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE C LIN M.D.

Provider Business Mailing Address
First Line	:	71 GLEN COVE RD
Second Line	:	SUITE A
City	:	GREENVALE
State	:	NY
Zip	:	11548-1056
Country	:	US
Telephone Number	:	516-625-8804
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 GLEN COVE RD
Second Line	:	SUITE A
City	:	GREENVALE
State	:	NY
Zip	:	11548-1056
Country	:	US
Telephone Number	:	516-625-8804
Fax Number	:

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

Provider Enumeration Date	:	09/13/2008
Last Update Date	:	09/13/2008

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