1386671071 NPI number — LIN XU M.D.

Table of content: LIN XU M.D. (NPI 1386671071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386671071 NPI number — LIN XU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
XU
Provider First Name:
LIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1386671071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BETHANY RD
Provider Second Line Business Mailing Address:
SUITE 35
Provider Business Mailing Address City Name:
HAZLET
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07730-1663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-888-1203
Provider Business Mailing Address Fax Number:
732-888-1204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BETHANY RD
Provider Second Line Business Practice Location Address:
SUITE 35
Provider Business Practice Location Address City Name:
HAZLET
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07730-1663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-888-1203
Provider Business Practice Location Address Fax Number:
732-888-1204
Provider Enumeration Date:
06/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MA071279 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P2870156 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7070477 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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