1184889081 NPI number — PHYSICAL MEDICINE AND TREATMENT CENTER JOSEPH Y LIN M D P A

Table of content: (NPI 1184889081)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184889081 NPI number — PHYSICAL MEDICINE AND TREATMENT CENTER JOSEPH Y LIN M D P A

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:
PHYSICAL MEDICINE AND TREATMENT CENTER JOSEPH Y LIN M D P A

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184889081

Entity Type Code:
Organization

Replacement NPI:

Last Update Date:
02/14/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 RUSSELL AVE

Provider Second Line Business Mailing Address:
SUITE 101

Provider Business Mailing Address City Name:
GAITHERSBURG

Provider Business Mailing Address State Name:
MD

Provider Business Mailing Address Postal Code:
20877-2966

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
301-590-0722

Provider Business Mailing Address Fax Number:
301-590-1154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 RUSSELL AVE

Provider Second Line Business Practice Location Address:
SUITE 101

Provider Business Practice Location Address City Name:
GAITHERSBURG

Provider Business Practice Location Address State Name:
MD

Provider Business Practice Location Address Postal Code:
20877-2966

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
301-590-0722

Provider Business Practice Location Address Fax Number:
301-590-1154

Provider Enumeration Date:
07/21/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LIN

Authorized Official First Name:
JOSEPH

Authorized Official Middle Name:
Y.

Authorized Official Title or Position:
DIRECTOR

Authorized Official Telephone Number:
301-590-0722

Provider Taxonomy Codes

Taxonomy code: 208100000X , with the licence number: D32137 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .